Orthopedic and Ambulatory DisabilitiesLevels of InjuryHeart and CirculationTemperature ControlBladder and Bowel IssuesWeight Management & OsteoporosisTransfersPressure Sores & Skin BreakdownMuscle SpasmsApply your knowledgeCongenital and Acquired ParalysisSpina BifidaSlide 13Types of Spina BifidaMeningomyelocele (MM)MeningoceleOccultaTreatmentsSlide 19Slide 20ShuntingWheelchair Sports and ActivitiesSports WheelchairsBasketball and TennisTrack and FieldHandcyclesRugby, Hockey, FootballClimbingSkiingAll TerrainSport WheelchairsFifth WheelCamberStraps and Side-guardsSize and SetupWheelsSlide 37ClassificationClassification SystemsOrthopedic and Ambulatory DisabilitiesWheelchair Sports and ParalympicsLevels of InjuryParasQuadsComplete and incomplete / partialFunctional level and Injury levelHeart and CirculationHypotension – Low Blood pressureBlood pools in legsAutonomic DysreflexiaT-6 & aboveTemperature ControlParas QuadsBladder and Bowel IssuesSpastic and flaccidCatheterizationIntermittent CatheterizationExternal/Condom Catheter (Males Only)Indwelling Catheter (Health Risks) Suprapubic Catheter Other Surgical OptionsKidney infectionsBladder infectionsWeight Management & OsteoporosisFitnessWeight Gain due to inactivityUsing smaller musclesWeight bearingBone deteriorationTransfersStrength must be developedRotator cuff wear and tearIndependenceEasier transfers = more independencePressure Sores & Skin BreakdownPreventionProblemsMuscle SpasmsWhat are they?Good and badApply your knowledgeGroups of 2 Given disability levelSpend a few minutes evaluating disabilityBladder, bowel, legs, hands, feeling, spasms, temperature, sweating, autonomic dysreflexia, transfers, etc. Share with classCongenital and Acquired ParalysisAcquired – Injury after BirthCongenital – Injured from BirthGenerally Speaking:Persons with acquired conditions out perform persons with congenital conditions in sports, fitness and movement.Spina BifidaA congenital defect of the spinal column caused by failure of the neural arch of a vertebra to properly develop and enclose the spinal cord. Generally occurs between the 4th and 6th week of pregnancySecond most common cause of congenital paralysis – next to CPSpina BifidaNon-progressive conditionGenerally does not get worseHigher the lesion – the more serious the paralysisMost are T-12 or belowNo cure – except for new fetal laser surgeryTypes of Spina BifidaMeningomyeloceleMeningoceleOccultaMeningomyelocele (MM)Most common form of Spina BifidaTumor sac is filled with spinal fluidCleft is in spinal columnSpinal cord and nerve roots exit through spinal cleft into the tumor sacThe most severe form – almost always cause paralysisMeningoceleCleft in spinal columnTumor sac fills with spinal fluidOnly the spinal cord covering (meninges) pooches into the tumor sacSpinal cord and nerve roots are not displacedSecond most severe form – sometimes causes paralysis – sometimes causes muscle weakness and movement problemsOccultaConcealed under the skinDoes not generally cause paralysisGenerally does not cause paralysis - sometimes causes adult back painSometimes a birthmark, dimple or tuft of hair is evidentMost times not diagnosed unless back is x-rayedTreatmentsPost-natal surgery – close the cleft in the column and remove nerve roots and cord from tumor sacOrthodicsTreatmentsShunting HydrocephalusCaused by spinal fluid build up in the cranium. Many are born with this – other develop this condition after post-natal surgery. The increased fluid needs to be re-routed after the cleft is closed.TreatmentsShuntingA one way valve and tube from the ventricles in the cranium threaded under the skin down to the abdomenExcess fluid is absorbed by blood vessels and membranes surrounding internal organs.ShuntingKids with shunts sometimes have severe headaches, seizers or skin irritation around the shunt route.Additional surgery is required as child grows and shunt needs to be adjustedAvoid activities that might cause blow to the head or pressure on shunting areaSoccer (heading), forward rolls, head stands.Wheelchair Sports and ActivitiesBasketballRugbyTennisFootballTrack and FieldHockeySwimmingHandbikingScubaWater SkiingSnow SkiingSky DivingRock ClimbingMountain ClimbingSeated Aerobics WeightliftingAnd many more...Sports WheelchairsFor every sport there is a chairBasketball and TennisInvacare TransformerColours TennisEagle HurricaneInvacare TitaniumTrack and FieldEagle RacerInvacare RacerEagle FieldHandcyclesInvacareQuickie AttachmentQuickie Kids CycleRugby, Hockey, FootballColours HammerEagle Rugby QuickieClimbingOne-Off Titanium, Inc.SkiingQuickie Kan SkiAll TerrainColours TremorEagleSport WheelchairsFifth wheelCamberStraps and Side guardsSize and SetupWheelsFifth WheelStabilityRange of motionFourth, fifth or sixth wheelCamberTurningStabilityPer4Max BasketballPer4Max everydayStraps and Side-guardsA must in every activity Chair responds to any movementReduces injurySize and SetupBased on height, weight, and disabilityWheelsBased on sport and disabilityX-coreSpokesSpinergy SpoxOutdoor wheelWheelsCasters—roller bladesSpoke guardCorima racing wheelSpoked racing wheelCoated hand rimClassificationBasketballMedical model (USA)Class 1, 2, or 3Other sports Track SwimmingRugbyTennisClassification SystemsPurposeLevel the playing playing fieldLevel of injuryLevel of