Luke E. Kelly

chapter

16

Spinal Cord Disabilities

Spinal Cord Disabilities

• Common spinal cord injuries– Traumatic injuries: quadriplegia and paraplegia– Spina bifida– Polio

• Spinal column deviations– Scoliosis– Kyphosis and lordosis– Spondylolysis and spondylolisthesis

Classification and Function

• Classification systems– Medical– Sport

• Relevant factors– Respiration– Shoulder, arm, hand control and sensation– Trunk stability– Hip, knee, ankle control and sensation– Bowel and bladder control– Quadriplegia and paraplegia

Handling Potential Spine Injuries

• Treat all possible injuries as serious.• Immobilize neck.• Restore breathing and circulation.• Summon medical help.• Keep victim warm.

Treatment Phases

• Hospitalization—acute medical treatment• Rehabilitation

– adjustment to injury– basic living skills

• Return to home or school—transition back to a normal routine

Secondary Issues

• Psychological acceptance• Health conditions

– decubitus ulcers– bruising– urinary tract infections– spasticity– contractures– obesity

Spina Bifida

• Spina bifida classifications– occulta– meningocele– myelomeningocele

• Hydrocephalus—shunts• Chiari II malformation• Tethering of the spinal cord

Contrast Similarities and Differences

• Acquired spinal cord impairments– psychosocial acceptance and development– physical and motor development

• Congenital impairments—spina bifida– psychosocial acceptance and development– physical and motor development

Polio

• Incidence

• Cause

• Salk vaccine

• Postpolio syndrome

Fitness and Spinal Cord Injuries

• Obesity• General level of fitness?• Emphasis

– flexibility– strength– endurance

• Dealing with muscle imbalances• Brockport Physical Fitness Test

Fitness and Safety

• Hypotension

• Thermoregulation

• Autonomic dysreflexia

Posture Screening

• Role of physical educators• Screening tools

– posture grid– Iowa posture test– New York State Posture Rating Test

• Coordination with other personnel

Spinal Column Deviations

• Scoliosis

• Kyphosis

• Lordosis

• Spondylolysis and spondylolisthesis

Classifications

• Classification– structural– nonstructural

• Causes– idiopathic– neuromuscular

• Incidence

Scoliosis

• S-shaped curves– primary– compensatory

• C-shaped curves• Treatment

– nonstructural– structural– braces

Treatment of Spinal Deviations

• Establish policies and procedures.• Work on both strength and flexibility.• Make routines fun and motivating.• Employ appropriate warm-up and cool-down

periods. • Emphasize static over dynamic stretching.• Integrate programs into the regular physical

education program. (continued)

Treatment of Spinal Deviations (continued)

• Make sure students understand and can do the exercises correctly.

• Encourage students to watch themselves in mirrors when they exercise.

• Make sure program is followed outside physical education

• Emphasize symmetrical exercises.• Be aware of limitations imposed by braces.

Orthotic Devices

• AFOs• KAFOs• HKAFOs• Canes, walkers, and crutches• Wheelchairs—hospital vs. sport chairs

Inclusion

• Focus on abilities.• Inclusion is a two-way street.• Substitute objectives: Wheelchair skills for

locomotor skills.• Make decisions based on assessment data.• Make accommodations to ensure . . .

– success– learning

• Teach self-advocacy.

Sports

• Opportunities– events– levels of competition

• Organizations– Wheelchair Sports, USA

• Formally National Wheelchair Athletic Association

– Disabled Sports USA• Formally National Handicapped Sports

Wheelchair Basketball

• NWBA classification system– Class I: T7 and above– Class II: T8–L2– Class III: L3 and below

• Team rules– 5 players– Total of 12 points on the floor– No more than three class III players