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Epilepsy Athletes with a disability may be more prone to seizure activity than nondisabled athletes. The research literature suggests that persons diagnosed with brain injury, cerebral palsy, mental retardation, hydrocephalus, and other neurological disorders are especially prone to seizure activity. Although seizures can be problematic in the sports environment, most persons with seizure conditions can safely engage in recreation and sport activities given appropriate care from physicians and prudent behavior on the part of the athlete. Medical attention is needed to determine the appropriate dose and administration of anti-convulsant medications, as well as advice on appropriate sport choices and training regimens. Athletes with seizure conditions should comply with medication routines and should work to control factors which may precipitate seizures such as fatigue, emotional stress, physical stress, head trauma, strobe lights, red lighting, alcohol, steroids, stimulants, and recreational drugs. In some cases, regular aerobic physical activity helps to prevent seizures, and in other cases lower doses of anti-convulsant medications are needed when the individual engages in regular exercise. In a survey completed by Bennett (in Goldberg, 1995) physicians contraindicated the following sports for participation by individuals with known epilepsy. These are listed below based on the severity and frequency of seizure activity:
Coaches and trainers should be aware of athletes who are diagnosed with seizure conditions. These athletes should be monitored during warm-up, activity, and cool-down phases of all training and competition sessions so that appropriate care can be provided in the event of a seizure. Coaches should be especially vigilant during transitions from work to rest periods (such as the cool-down phase of workouts), since this is a time when seizures typically occur. In situations where a seizure has occurred, the following first aid protocol is recommended: protect extremities by removing obstacles; place a soft object (pillow, article of clothing) under head to protect head (if timely); time the seizure from onset to stop; never restrain extremities; in aquatic activities assure that the head is supported above water. When the seizure subsides, gently turn the head to the side to assure an open airway, contact family or caregiver, and allow the athlete to rest. Paramedics should be contacted only when the athlete injures self during seizure, the person is not a known epileptic, the seizure exceeds 10 minutes in duration, or the fear of continued seizure activity exists (status epilepticus). Mental retardation Individuals with cognitive impairments should have insight into the safety issues of sport participation. Care givers and family members should be involved in sports medicine training to assure carryover in preventative and treatment protocols. Verbal rehearsal techniques are effective teaching strategies for the person with moderate to mild levels of cognitive impairment. Athletes with mental retardation have a higher incidence of seizure activity (refer to "epilepsy" this section). The individual with Down syndrome should be monitored for atlanto-axial instability. It is reported that 10 - 20% of those persons with Down syndrome have this inherited trait. Atlanto-axial instability is a malalignment of the C-1 through C-2 vertebrae. Individuals with this complication should be restricted from sports that elicit hyperextension or excessive flexion of the neck as well as direct pressure to the spine. Activities typically contraindicated include but not be limited to diving, equestrian, gymnastics, alpine skiing, ski jumping, butterfly, and others. An x-ray is the primary method to assess whether athletes with Down syndrome have this secondary compounding factor. Hydrocephalus is another diagnosis resulting in cognitive impairment. Hydrocephalus is caused by the body's inability to absorb cerebrospinal fluid. This disorder is successfully treated by surgically placing a "shunt" from the ventricle to the stomach to drain the excessive fluid. Fear of shunt displacement often contraindicates participation in contact sports (i.e., soccer and diving). Individuals with this type of disability also need to be monitored for personality changes which may indicate a shunt malfunction, such indicators may include changes in mood, headaches, dislike for bright lights, nausea, and vomiting. Medical intervention should be sought in cases where shunt integrity is questioned. Multiple sclerosis Individuals with multiple sclerosis (MS) should engage in recreation and sport to the degree they feel comfortable and to their tolerance. Tolerance levels will vary from individual to individual. Since MS is a progressive neuromuscular disorder, fatigue and stress (emotional and physical) may elicit attacks on neuromuscular functioning. Each attack causes increased disability. Therefore competitive activity is generally contraindicated in lieu of recreation participation. Swimming is occassionally contraindicated for the patient with MS, however it may be tolerated for short periods of work in water temperature 80 - 84 degrees. Other activity is recommended to tolerance. The coach or instructor may need to monitor the participants activity level assuring minimal to no fatigue following participation. Boccie, bowling, archery and other less physically draining sports are generally recommended. Muscular dystrophy The same precautions as indicated this section with multiple sclerosis should be followed for the individual with muscular dystrophy. However, aquatics has less negative effect and is often recommended (but again to tolerance). Additionally water temperature can be more therapeutic in nature (90 - 94 degrees) to reduce spasticity with less adverse effect as seen in the individual with multiple sclerosis. Poliomyelitis The precautions for persons with polio are the same as those noted for persons with with spinal cord injuries (this section) with the following exceptions: may affect upper extremities, excretory functioning maintained and generally normal sensation. The individual should be monitored for post-polio syndrome when facilitates joint pain, muscular weakness, and fatigue. Athletes with this diagnosis may benefit more from recreational sport than from competitive participation. Spinal cord injuries Individuals with spinal cord injuries frequently experience injuries to the shoulders, wrist and hands. Repetitive motion syndromes or over-use problems are common and include such conditions as rotator cuff impingement, carpal tunnel syndrome, and acute muscular tears. Most injuries occur to athletes who participate in road racing and basketball. Proper training protocols can assist to reduce the likelihood of injuries. Warm-up and cool-down stretching is highly recommended to avoid injury and pain. The RICE technique should additionally be utilized as a training strategy (see "treatment of injuries" this section). The individual with a spinal injury should train no more than three days per week or utilize an alternate day training strategy with respect to intensity of mode of exercise (i.e., MWF intense training and TTS moderate/light training, or MWF road race and TTS swim). Flexibility and strength should be a focal point of the training regime to reduce likelihood of over-use syndromes. Proper equipment is also considered essential to injury prevention. Spoke guards and gloves or taping should be utilized to protect the hands from injury. Adequately padding the wheelchair seat can prevent or reduce the likelihood of pressure sores. Proper clothing to protect the underarms from chafing is also recommended. Individuals with high level spinal injury will experience difficulties with body temperature control. It is recommended that they wear light clothing, seek shaded areas when not participating in events, increase fluid intake, and use cool towels or spray bottles to maintain comfort and proper body temperature. The individual with a spinal injury may also experience circulatory problems which can lead to light headedness or pressure sores. It is recommended that the individual reposition self in chair, perform chair lifts frequently, and passively complete range of motion exercises to the lower extremities to avoid these complications. Pressure sores occur when blood flow is inhibited resulting in the deterioration of surrounding tissue. Pressure sores occur most to the feet, back of the thighs, and buttocks. The athlete should be encouraged to routinely check for pressure sores and frequently reposition self. The following procedure should be utilized to rule out the occurance of a pressure sore: (a) identification of red area on the skin; (b) press one finger firmly in the center of this area and hold for 4 seconds (this area will turn white); (c) wait approximately one minute; and (d) if area remains white, it is an indication that minimal blood is circulating to this area of the body and medical consult should be sought immediately. Bowel and bladder complications are also identified as issues for the person with a spinal cord injury. Urinary tract infections are common with individuals with spinal injuries requiring medical intervention. Some athletes may have urine catchment devices or use intermittent catheterization to empty the bladder. It is critical that regular catheterization schedules are maintained throughout athletic competition and practice. An over-distending bladder can lead to dangerous and even life threatening complications known as autonomic dysreflexia. The literature suggests that some athletes with spinal injuries purposefully over-distend the bladder to obtain a competitive edge (refer to Long, et al., 1997 this section). This technique is known as "boosting" and is particularly problematic for athletes with high level spinal injuries. Symptoms of autonomic dysreflexia are high blood pressure (sometimes to critical levels), headache, chills, and sweating. The following strategies are recommended to prevent autonomic dysreflexia: empty bladder prior to competition, assure a clear line to leg bag or other urine catchment device, given athlete complaint of the above symptoms cease activity, and seek medical consult. Lack of sensation can also be a complication that can lead to medical concern for the athlete with spinal injury. The athlete with this deficit is often unaware of abrasions, lacerations, bruising, or even fractures. It is recommended that athletes with impaired sensation visually check body for injuries following collisions in wheelchair sports. Shin pads and other protective gear should be worn to prevent injury (i.e., socks in the swimming pool, seat cushions). Additionally, those athletes that engage in alpine skiing, nordic skiing, sledge hockey, and other winter events should dress in layers to prevent hypothermia. Osteoporosis (brittle bones) and scoliosis (lateral curvature of the spine) are orthopedic complications that are associated with long term spinal injury. Due to the nature of osteoporosis, contact sports are contraindicated. Weight bearing and increased calcium intake are recommended to facilitate improved bone density. Scoliosis is surgically treatable. However, given significant curvature forward flexion with weight bearing or activity causing spinal compression are contraindicated. Respiratory complications are common amongst athletes with high level spinal injury. In the case of respiratory infection, the athlete should be removed from competition, training and seek medical consult/treatment. Deep breathing exercise and frequently changing positions and/or postures should help to alleviate this problem. Visual impairments Sighted guides can easily allow the athlete who is blind or partially sighted to become active in sports. A guide can assist an athlete in becoming "grounded" to the environment and identify any potential hazards via verbal cuing. Individuals with detached retina should not engage in activities where a blow to the head is likely (i.e., soccer). Additionally, the literature suggests that those with glaucoma should avoid activities that might cause intraocular pressure (i.e., powerlifting, diving). Treatment of injuries The following ar recommended first aid procedures that should be followed when an athlete is injuried. However, a physican or trainer should be constulted with any and all injuries to athletes. In assessing the extent of injury the "HOPS" technique is recommended:
The "RICE" technique is recommended as a generic treatment of soft tissue injuries:
|
 | Athletes with disabilities injury registry |
| An overview of common injuries to individuals with disabilities: Part I |
| Managing common injuries in individuals with disabilities: Prevention comes first, Part II |
| Managing common injuries in individuals with disabilities: Evaluation, treatment & rehabilitation, Part III |
| Managing common injuries: The ultra-stretch - A method for increasing flexibility, strength, and endurance, Part IV |
| Wheelchair basketball injuries |
| Incidence of injury in amputees playing soccer |
| Adolescent sarcoma patients' intense rehabilitation with exercise program |
| Survey of wheelchair athletic injuries - Common patterns and prevention |
| Autonomic dysreflexia and boosting in wheelchair athletes |
| The injury experience of the competitive athlete with a disability: Prevention implications |
| Shoulder pain in wheelchair athletes: The role of muscle imbalance |
| Athletes with disabilities: Removing medical barriers |
| Epilepsy and athletics |
| Exercise limitations for quadriplegics |
Ferrara, M., & Buckley, W. (1996) Athletes with disabilities injury registry. Adapted Physical Activity Quarterly, 13, 50-60.
Three hundred nineteen athletes from a variety of sport disability organizations participated in a two year study to obtain data investigating the type of injury, frequency, and intensity of injury occurring to athletes with disabilities. A prospective, epidemiological, and cross-disability research design tool was selected for data collection purposes, entitled the Athletes with Disabilities Injury Registry (ADIR). Two recording forms were utilized; the first to collect data regarding the injury and the second to collect data regarding the frequency and duration of sport participation. The data obtained regarding injuries included: the site of injury, when it occurred, medical intervention required, sport under which injury occurred and sport safety equipment utilized. The second form was essentially a calendar requiring athletes to record daily the frequency and duration of sport participation to include the actual sport, the time of day, length of session and date of session. The athletes from the Disability Sports Organizations that participated in the 1990 summer Paralympic games were selected for participation in this study. These included athletes from the National Handicapped Sports (NHS), the United States Association of Blind Athletes (USABA), the United States Cerebral Palsy Athletic Association (USCPAA), and the Wheelchair Sports-USA (WSUSA). The project began in April 1990 and concluded in September 1992. Athletes were asked to complete the calendar and return it to researchers bi-monthly while completing injury forms with occurrence. Statistical analysis took the form of frequency of injuries with tabular analysis to identify injury trends.
One hundred, twenty-eight injuries were reported in the two year time frame. 79.7% were musculoskeletal and 20.3% were disability related problems. Upper extremity injuries were the most prevalent with data reflecting 35.9% injuries overall followed by injuries to the torso, head and neck at 22.7% collectively. Lower extremity injury were least involved at 21.1% and illness was documented 20.3% of the time over the two year period. 52% of the injuries were considered minor (7 days or less lost time), 29% of the injuries were considered moderate (8 - 21 days of lost time), and 19% of the injuries were considered major (22 or more days of lost time). 15% of the moderate and major injuries were not medically assessed.
According to the authors, the rate of injury found in this study was similar to the rate of injury reported by other athlete populations.
Stopka, C. (1996). An overview of common injuries to individuals with disabilities: Part I. Palaestra, 12(1), 44-51.
This article consists of a general review of the literature which identifies the primary injuries that occur in sports in persons with disabilities. Road racing, basketball, track, and tennis are reported as having the highest incident of injuries. Moderate level of injury risk occur through participation in field events/athletics, weight training, swimming, and archery. Those activities demonstrating low incidence of injury include billiards, bowling, table tennis, and slalom. Shoulder and elbow injuries are most common in wheelchair sports. Blind athletes experience injuries primarily to the lower extremities . Athletes with cerebral palsy indicate injuries to knees, shoulders, arms/wrists, and leg/ankles (in progressive order of significance). Common injuries or medical complications associated with sport participation include muscle strain, abrasions, blisters, wrist injuries (especially carpal tunnel syndrome), lacerations, shoulder injuries (especially rotator cuff impingement syndrome), decubitus ulcerations, temperature regulation disorder, osteoporosis, obesity, and various organic disorders (ie. blood pressure responses, distended bladder or colon). Athletes with mental retardation are noted to have special health risks to include cardiac anomalies, cerebral palsy, asthma, and atlanto-axial instability.
Stopka, C. (1996). Managing common injuries in individuals with disabilities: Prevention comes first, Part II. Palaestra, 12(2), 28-31.
This article provides an overview of preventive strategies that would reduce the likelihood of injuries during athletic competition and/or participation by persons with disabilities. These strategies included basic conditioning principles, proper equipment, biomechanics, nutrition, and communication. Proper training to include adequate levels of work and recovery were discussed. Conditioning programs are recommended for implementation three to five sessions per week. Proper equipment was also identified as a necessary component of injury prevention. Padded work out gloves and spoke guards are highly recommended for the wheelchair racer. Socks should be worn by swimmers with neuromuscular or sensory disorders to prevent foot scrapes. Those who have difficulty transferring into a swimming pool should utilize sliding boards or mats to avoid potential hip/lower extremity abrasions or lacerations. Protective clothing should also be worn by individuals with body temperature control issues to eliminate the likelihood of hypothermia. Additionally, sport specific clothing should be worn to protect skin, decrease wind resistance, and protect against thermal stresses. Helmets are also recommended for individuals who participate in velocity sports. Biomechanics and/or positioning was key to eliminating or minimizing the likelihood of rotator cuff impingement and carpal tunnel syndrome. Proper orthotics were also noted as significant to the needs of individuals with gait anomalies (i.e., cerebral palsy). A well balanced nutritional regime was also indicated as a need for all athletes. Pasta, vegetables, fruits, and grains were recommended with less focus on meats and dairy products (unless low fat). Adequate hydration before, during and following sport participation was also recommended.
Stopka, C. (1996). Managing common injuries in individuals with disabilities: Evaluation, treatment & rehabilitation, Part III. Palaestra, 12(3), 32-38.
Strategies for the treatment and prevention of common injuries are reviewed in this article. When injury occurs athletes and coaches are encouraged to utilize the "HOPS" technique to assess extent of damage. This systematic technique directs the coach or athlete to obtain a history regarding the injury (H), observe the affected site (O), palpate the affected area for deformities, pain, etc. (P), and stress the affected area to determine the extent to which active and passive movement is impaired (S). It is noted that persons with disability often swell at a lower rate than nondisabled persons secondary to circulatory issues. Persons offering immediate treatment should follow the RICE protocol. This systematic process of treatment suggests initial rest (R), application of ice (I), compression (C), and elevation (E) of the affected area. Rehabilitation from injury should follow a progressive return to sport participation. These stages are identified as the prehab, early, middle, late and return to sports. Prehab is a preventative mode that assures the body is in the best possible level of fitness to assure a more rapid recovery. The early stage addresses increased range of motion and isometric strengthening exercises. The middle phase involves strength, endurance and range of motion training to approximately 50% of norm. The late phase of rehabilitation places a person at 90% of normal functioning and return to sports occurs when the person is functioning at 100% of normal strength, endurance and range of motion. At this final stage of recovery the authors recommend that an athlete is able to return to sport, specifically those activities requiring significant balance, coordination, speed, and power.
Stopka, C. (1996). Managing common injuries: The ultra-stretch - A method for increasing flexibility, strength, and endurance, Part IV. Palaestra, 12(4), 40-45.
An overview of the "ultra stretch" training method as an approach to preventing injuries in athletes with muscular contracture which restrict range of motion. Diagnostic groups that might benefit from this intervention include: traumatic brain injured, cerebral vascular accidents/strokes, multiple sclerosis, and even those with arthritis. The intervention requires that the athlete place the muscles to be stretched in a comfortable yet stretched position, isometrically contract these muscles and hold the contraction for approximately eight seconds, finally they are requested to relax the muscles and observe the difference in range of motion. This technique is expected to increase range of motion every time and is recommended to be repeated several times a session. This technique works because it stimulates the proprioceptors (golgi tendon organs) to facilitate relaxation through muscular fatigue. Successful case studies were presented in the article with persons with both upper and lower extremity involvement. In one case, an individual with significant upper extremity tone could assume a near normal grip given four months of repeating this technique.
Burnham, R., Higgins, J., & Steadward, R. (1994). Wheelchair basketball injuries. Palaestra, 10(2), 43-49.
The purpose of this study was to identify the type and severity of injuries sustained by athletes who participate in wheelchair basketball and to make recommendations to assist in appropriate training methods based on the type of injuries incurred. Recall questionnaires were distributed to athletes who participated in wheelchair basketball tournaments which occurred between January and April 1990. Six tournaments were held in Canada while the remaining were international competitions. One hundred and sixteen questionnaires were completed. Rate of return was estimated at 65%. Athletes were asked to identify demographic data (i.e., disability, duration of disability, wheelchair basketball position, number of years in wheelchair sport, etc), training methods utilized (i.e., duration and type of training, number and type of wheelchair sports in which they participate, training approach, etc), equipment (i.e., protective gear utilized, seat alignment, wheelchair propulsion technique, etc.), and the injuries incurred through participation in wheelchair basketball over the past year (i.e., location of injuries, type of injury). Descriptive statistics were utilized to analyze data related to demographics, injury incident and equipment. The athletes were divided into two groups, those who sustained injuries and those who had not sustained injuries. The demographic data on these two groups were compared utilizing a chi-square analysis for discrete data (i.e., gender, disability type, playing position, seat type, protective gear, etc) and a one-way analysis of variance for the continuous data (i.e., age disability duration, training frequency, training techniques, etc.).
189 injuries were reported. 82% of the athletes indicated at least one injury during the year. 87% of the injuries occurred in the upper extremities. 18% of these injuries were considered significant resulting in time lost from wheelchair basketball participation. 85% of the significant injuries affected the shoulder, elbow, and wrist. Only 13% of the hand injuries resulted in lost time from wheelchair basketball competition or practice. No equipment factors were associated with injury. Shoulder injuries were associated with playing the wheelchair basketball position of center. Most respondents (athletes) were male, right handed and had a mean age of 29.2 with a mean disability duration of 16.6 years and had participated in wheelchair sport for 7.1 years with an average of 6.5 years in wheelchair basketball. 40% of the respondents participated only in wheelchair sports, 20% participated in two wheelchair sports, and 5% participated in three or more wheelchair sports. 96% indicated they stretched prior to activity but only 25% stretched following activity. Post-activity icing was reported only 17% of the time.
Wheelchair basketball injuries occur primarily to the upper extremities. Shoulder, elbow and wrist injuries were the most significant injuries reported. Significant injuries were associated with number of training days (increased number of training days increases incidence of injury). Overuse and inadequate recovery period are significant issues for athletes with mobility impairment. Those persons who participate in sports in addition to wheelchair basketball were nine times more likely to incur significant injury than those that participate in only basketball. Playing the center position increases the likelihood of rotator cuff injury. Significant injuries also increased when wheelchair basketball participants were involved in weight training.
To reduce injuries, the authors recommend involvement in only one sport at a time, a training frequency of no greater than three times weekly, and appropriate use of stretching, icing, training patterns, and hand protection.
Kegel, B., & Malchow, D. (1994). Incidence of injury in amputees playing soccer. Palaestra, 10(2), 50-54.
The purpose of this study was to investigate the injuries sustained among athletes who participate in amputee soccer. It is reported that the majority of injuries sustained by able-bodied athletes in this sport are injuries to the lower extremities especially to the knees. A questionnaire was distributed to the athletes that participated in the Fourth and Fifth Annual International Amputee World Soccer Cup Tournament held in September 1989 and September 1990. The athletes in this sport have lower extremity amputations with the exception of the goalie who have upper extremity amputations. All athletes play without protheses. The questionnaires investigated demographic information regarding the individual, his/her disability, duration in soccer, type of injuries incurred as a result of soccer participation, and perceived benefit in sport (soccer). The first aid teams were additionally asked to provide documentation regarding injuries sustained during the tournaments.
89% response rate on surveys. Three women and seventy-two men responded, with mean age of 29. 78% of those surveyed had acquired their amputation and the majority had incurred the amputation at the age of 18. 19% of the respondents had upper extremity amputations with the remainder having lower extremity amputations. Athletes had reported playing soccer for an averge of 2.8 years (at the 1990 tournament). 52% had never sustained injuries while playing soccer. Of those that had sustained injuries the majority involved injuries to the knee, ankle, face and shoulder which the author reports as similar to those injuries incurred by able-bodied athletes who participate in this sport. The questionnaire did not investigate the severity and functional impact of the injuries. It should additionally be noted that the athletes perceived they benefited physically, socially and emotionally from playing soccer. Athletes also perceived that sport participation was an important factor in assisting in the emotional adjustment to their amputations.
Rossbach, P., Kreuter, P., & Balsley, D. (1993). Adolescent sarcoma patients' intense rehabilitation with exercise program. Palaestra, 9(4), 47-50.
The adolescent sarcoma patients - intense rehabilitation with exercise program (ASPIRE) was a strengthening and aerobic exercise program implemented 3 times weekly, for one hour sessions, over a duration of six months. The authors report that previous research indicates that amputees wearing prothesis, expend 20 - 100% more energy per kilogram of body weight to ambulate than persons without amputations. The current research project was designed to measure the effect of an intense strengthening and aerobic exercise program on the cardiovascular fitness of the participant. 116 participants began the program with nearly 64% completing. All participants were between the ages of 7 and 75. Cancer patients were required to be off chemotherapy and be tumor-free. All cancer patients who had received chemotherapy that may have adversely affected cardiac functioning had to be evaluated and approved by their cardiologists. All non-tumor patients had to obtain physician authorization to participate. All participants had an acquired lower extremity amputation, received traditional rehabilitation services, and worn a prothesis for a minimum of one year.
The Douglas bag technique was used to measure energy expended at rest, during walking, and during speed walking. Heart rates were measured at intervals throughout the exercise regime. Stride analysis was also analyzed using a switch stride analyzer. Energy cost measurements included: net energy cost (NEC), velocity (VEL), speed walked in meters per minute, amount of oxygen required per meter walked compared with body weight, and normalized energy rate (NER), per minute oxygen requirements to maintain levels of kinetic energy, and heart rates.
The fitness programs were implemented throughout a six month period of time, three times weekly, for sessions of one hour duration. The first half hour focused on strengthening exercises and the second half hour focused on aerobic exercise (with participants heart rates elevated to 60 - 75% of maximum heart rate (HR) capacity.
Results indicated that significant improvements were noted in NEC (net energy cost), NER (normalized energy rate), and VEL (velocity). Additionally, gait symmetry improved in the above the knee (AK) group but did not improve significantly with the below the knee (BK) group.
Based on positive results, the authors offered the following programmatic recommendations:
1. Lightweight rigid dressing or lightly compressing ace bandages should be utilized to reduce swelling immediately following surgery.
2. Physical therapy one day post surgery.
3. Cast for the preparatory prosthesis following the third post surgical day.
4. Utilize a cycle ergometer for aerobic conditioning before suture removal.
5. Address functional strengthening.
6. Address gait to include visual feedback (use of mirrors), treadmill work (progressively), and advanced gait training to include gait cross-over patterns, sports competition and running.
Curtis, K., & Dillon, D. (1986). Survey of wheelchair athletic injuries - Common patterns and prevention. In C. Sherrill (Ed.), Sport and disabled athletes: The 1984 olympic scientific congress proceedings (Volume 9, pp. 211-230). Champaign, IL: Human Kinetics.
This study was designed to determine the injuries that athletes with disability most commonly experience, as well as sport and training participation patterns associated with those injuries. A nearly 11% response rate was generated in a questionnaire distributed to 1200 athletes with disability who participated in wheelchair athletic competition. The questionnaire was intended to collect data regarding the athletes disability, sport participation, protective gear utilized, and history of injury occurring during sport participation. 79% of the responses were received from male athletes, 21% female, with a mean age of 29.25. Primary disability groups sampled were spinal cord injured (65%), post-polio (13%), congenital disorders (9%), amputations (3%), and other neuromuscular and musculoskeletal disorders (10%). 72% of those sampled indicated that they had incurred a minimum of one injury from sport participation. Some athletes reported as many as 14 injuries. Respondents indicated they averaged between 6 and 10 hours of sport participation weekly. The majority of injuries occurred in track (26%), basketball (24%), and road racing (22%). 79% of athletes were involved in track (79%), basketball (71%), swimming (61%), field events (69%), and road racing (57%). The most frequently sustained injuries identified were soft tissue injuries (muscle pulls, strains, sprains, tendinitis, bursitis occurring at the joints of the upper extremities) (33%), followed by blisters (18%), and skin abrasions and/or lacerations (17%).
Long, K., Meredith, S., & Bell, G. (1997). Autonomic dysreflexia and boosting in wheelchair athletes. Adapted Physical Activity Quarterly, 14, 203-209.
Autonomic dysreflexia is a secondary complication of spinal cord injuries above T-6 (6th thoracic vertebra). Due to the level of spinal cord injury the sympathic and parasympathic nervous systems (the two branches of the autonomic nervous system) are unable to work together to maintain the bodies homeostasis (heart rate, breathing, digestion, temperature regulation). Full bowel or bladder can trigger the "fight and flight" response of the sympathetic nervous system. In a person with high level spinal injury the parasympathic system is not triggered to calm the body down. The resultant effect is sudden onset hypertension, significant headache, increased spasticity, flushing, gooseflesh, and sweating. This response is known as autonomic dysreflexia (AD). AD can also be triggered by urinary tract infections, burns, childbirth, and ulcerations of the skin. If untreated, blood pressure can rise to life threatening levels and have been known to cause cerebrovascular accidents, blindness, and seizures. AD can be treated by emptying the bladder, loosening clothing, elevating the head or removing the triggering stimulus. If these interventions do not lower blood pressure, medical intervention is necessary.
Several case studies are presented to demonstrate the significance of AD. Two individuals, aged mid to late 30's, with diagnosis of quadriplegia, one being medically treated for bedsores and the other treated for fractured fibula experience elevated blood pressure caused by AD resulting in cerebral vascular accidents. In one case the CVA was fatal and in the second case the CVA was alleviated with unknown residuals. Three additional cases were identified that reported that AD was the cause of seizure activity in persons with cervical level spinal cord injuries. In these cases the AD was caused by urinary tract infections or improper catheter placement.
Athletes with quadriplegia estimate that 90% or more of their peers use self-induced AD to enhance athletic performance. This technique is known as "boosting". In one study, 7 of 8 athletes with quadriplegia admitted to inducing AD by over-distending their bladder. Objectively their athletic performance, in road racing, increased by nearly 10%. Subjectively the athletes reported increased endurance and arm strength as a result of "boosting". One subject indicated adverse side effects of shivering, headache, and fatigue. Subjects who boosted experienced moderate to severe levels of hypertension as a result of boosting.
The authors suggest that it is essential that coaches, athletic trainers, race officials and support personnel be aware of the symptoms, pathology, treatment and consequences of AD. Further research is additionally necessary as well as regulations to limit the practice of boosting.
Ferrara, M., Buckley, W., McCann. B. C., Limbird, T., Powell, J., & Robl, R. (1992). The injury experience of the competitive athlete with a disability: Prevention implications. Medicine and science in sports and exercise, 24(2), 184-188.
The authors presented a descriptive study designed to determine the injury experiences of persons with disability that participate in sport/athletics. Those sampled were participants of the 1989 national games of the National Wheelchair Athletic Association (NWAA), the United States Association of Blind Athletes (USABA), and the United States Cerebral Palsy Athletic Association (USCPAA). Data was gathered concerning the extent and degree of injury episodes. As it relates to preventative training protocol, most athletes reported strength and aerobic training two times weekly, anaerobic training one time weekly, and flexibility training three times weekly. 32% of athletes sampled reported at least one injury during the study period. Approximately 22% reported acute injury and 14% reported chronic injuries. Near equal frequencies of upper (44%) and lower (43%) extremity injuries were identified. NWAA athletes experienced the majority of injuries to the shoulder and/or arms/elbow at 57%. USABA athletes experienced the greatest injuries to the lower extremities at 31%. Finally, knee injuries accounted for 21% of the injuries sustained by the USCPAA games. Overall the shoulder was injured with the greatest amount of frequency, followed by injuries to the leg/ankle and then the knee. The authors note that flexibility, strengthening, and conditioning programs are recommended for athletes to decrease the amount of injuries incurred in sport participation.
Burnham, R., May, L., Nelson, E., Steadward, R., & Reid, D. (1993). Shoulder pain in wheelchair athletes: The role of muscle imbalance. American Journal of Sports Medicine, 21(2), 238-242.
The purpose of this study was to compare the isokinetic shoulder strength of able-bodied individuals to persons diagnosed with paraplegia (with and without noted rotator cuff impingement). Nineteen male wheelchair athletes (mean age 29) diagnosed with paraplegia participated in this study. Twenty able-bodied males considered moderately fit athletes with mean age of 25 acted as the control. Athletes underwent an isokinetic shoulder strength evaluation using a Cybex 340 dynamometer. Both shoulders were tested in adduction/abduction and internal/external rotation. Wheelchair athletes reported an average of 96 hours per week in their chairs with 13 hours spent in wheelchair sport. 26% of the athletics with paraplegia had rotator cuff impingement as defined by the researchers. Individuals with paraplegia were significantly stronger in shoulder adduction/abduction as well as internal/external rotation compared to the able-bodied members of the control group. However, shoulder abduction to adduction was significantly higher in wheelchair athletes as compared to able-bodied. The authors suggested that the wheelchair athletes with rotator cuff impingement had significantly weaker adduction and internal/external rotation compared to those without impingement. Additionally, the abduction to internal rotation ratio was significantly higher in the athletes with impingement indicating weakness to internal rotators. The authors suggest that muscle tone imbalance, chronic over use, repetitive impingement positioning are all contributing factors in to rotator cuff impingement. Strength training is recommended to shoulder internal/external rotators and adductors. Training schedules to include adequate recovery is additionally recommended. Reeducation in training activities/tasks that work in the shoulder impingement positions (i.e,. limit foul shot practice) and postural training are additionally recommended.
Peck, D., & McKeag, D. 9194). Athletes with disabilities: Removing medical barriers. The Physician and Sportsmedicine, 22(4), 59- 62.
A review of the medical barriers that may impede sport participation in individuals with disability. The authors note the majority of injuries reported by persons with disabilities include contusions, abrasions, lacerations, sprains and strains. Protective gear, improved training program, and improved biomechanics are recommended to reduce the upper extremity injuries common amongst wheelchair athletes. Sighted guides and other forms of supervision are recommended to reduce the lower extremity injuries common amongst individuals who are blind or partially sighted. Orthotics and improved conditioning programs are recommended for the athlete with cerebral palsy to reduce the incidence of knee injuries. Thermoregulatory dysfunction is also noted as a problem for athletes with spinal injury. Recommended preventative measures include adequate hydration and protection from extremes in environmental temperatures. Bladder problems are also noted with persons with cerebral palsy and spinal injury. Adequate hydration and proper excretion systems are recommended to assure limited issues with disability related bladder infections. Osteoporosis is a problem of wheelchair athletes that are restricted in weight bearing. Adequate dietary balances of calcium are recommended as treatment along with adequate chair padding. Pressure sores are also common amongst individuals with restricted mobility. Chair padding, properly fit wheelchair, frequent repositioning, and early aggressive medical intervention is recommended for treatment of this condition. Carpal tunnel syndrome is also noted as a secondary problem associated with spinal injury. Padded gloves and wheelchair rims, proper propulsion technique and properly fitted wheelchair are recommended to decrease the incidence of this repetitive motion syndrome.
Cantu, R. (1998). Epilepsy and athletics. In R. Cantu (Ed.), Clinics in sports medicine: Neurologic athlete head and neck injuries (Vol. 17, No. 1), Philadelphia, PA: Saunders.
Literature review describing the types, etiology, diagnosis and treatment of seizure disorders and/or epilepsy. Exercise is noted to inhibit seizure activity with true nature of such reaction unknown. Even though the literature contraindicates participation in contact and collision sports by persons with epilepsy, the authors report little empirical evidence to support this increased injury risk. Recreational swimming is recommended by the authors for persons with epilepsy given supervision. The authors report the highest evidence of risk of drowning involve children under the age of five that are unsupervised during bath time. Motor sports (ie. boating, motorcycling, auto racing) are not recommended due to the likelihood of catastrophic injury given a seizure while driving. The authors report that it should be an individuals choice to participate in activity where falls may occur (ie. cycling, gymnastics, horseback riding). The type of activity (ie. rock climbing) versus the frequency of seizure activity should be assessed prior to determining participation is these sports. The authors conclude by reporting both the physical and psychological benefits of physical activity for persons with Epilepsy.
Skuldt, A. (1984, May-June). Exercise limitations for quadriplegics. Sports 'n Spokes, 19-20.
The author reports that exercise limitations and demands of individuals with quadriplegia differ from other athletes. Quadriplegics experience lowered heart rates, development of lactic acid early in exercise, increased physiological demand (from arm work versus leg work), and lowered respiration rates. The person diagnosed as quadriplegic will experience maximal heart rate work between 100 to 120 beats per minute. This differs significantly to the athletes diagnosed with paraplegia that experience maximal heart rate at 200 beats per minute (similar to able-bodied). Therefore, the author recommends short bursts of anaerobic activity as the preferred training strategy for athletes with quadriplegia. Interval training (short periods of work followed by long periods of rest) is additionally recommended secondary to decreased respiratory functioning, deficits in temperature regulation, and rapid build up of lactic acid in the blood stream given increased upper extremity versus lower extremity work. Adequate hydration, shade and spray bottles are also recommended to assist with body temperature regulation.
Bennett, D. (1995). Epilepsy. In B. Goldberg (Ed.), Sports and exercise for children with chronic health conditions (pp. 89-108). Champaign, IL: Human Kinetics.
Goldberg, B. (Ed.). (1995). Sports and exercise for children with chronic health conditions. Champaign, IL: Human Kinetics.
Sherrill, C. (Ed.) (1986). Sport and disabled athletes. Champaign, IL: Human Kinetics.
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