n Higher incidence of hearing loss and visual disturbance.

Management of athletes with cerebral palsy Managing athletes with cerebral palsy depends very much on the severity of the condition. Many athletes with cerebral palsy are completely independent and require no help other than a little more input from the physiotherapist and sports massage therapist after a long flight. More severely affected athletes often travel with a carer who is well used to their needs. Managing spasticity and other soft-tissue issues helps to maintain the athlete’s mobility, comfort and effectiveness on the field of play. Within soft-tissue management,

there may be some balancing conflicts to be overcome. Reducing spasticity and muscle tone in one area can reduce stability in another. Working hard to overcome disability overall raises the spectre again of classification. Surgical management of these conditions lies outside the realm of this article. Physiotherapy, particularly in the management of spasticity, aims to: n Reduce excessive muscle tone n Maintain or improve range of movement and mobility n Increase strength and coordination n Improve comfort.

Interventions may also include the following: n Stretching: this helps to maintain the full range of motion and mobility of a joint, which aims to prevent contractures. To be effective, the prescribed stretching routine must be done on a regular basis, usually once or twice a day. n Strengthening: spasticity often leads to loss of strength in the spastic and surrounding muscles. Strengthening exercises are aimed at restoring strength to affected muscles, so that

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when tone is reduced through other treatments, maximum use of the limb is achieved.

AMPUTEE ATHLETES Many of the problems seen in amputee athletes arise from the stump-to- prosthetic interface (11). Problems include the following: n Pressures sores n Abrasions n Blisters n Rashes and skin infection n Choke syndrome: a condition in which venous return from the stump is impaired and allows venous and lymphatic pooling in the soft tissues, commonly in any space between the prosthetic cup and the stump. If not treated properly, this can result in skin ulceration, poor viability, deep scarring and fibrosis, akin to venous ulcer changes in chronic venous insufficiency in the lower limb n Change in balance and biomechanics: the lower limb prosthetic may be made slightly shorter to allow a cleaner swing phase. The excessive lumbar spine extension and lateral flexion to compensate for lack of power and poor prosthetic joint movement can cause low back and cervical pain n Phantom limb pain n Injury to the other limb due to overuse or through increased risk of falls.

A priority for treatment of skin conditions in stump care is to address the underlying cause, ensuring that limbs fit properly and that hygiene and daily assessment of the skin of the stump are undertaken as an athlete’s daily routine. Sometimes rest from activity or from wearing a prosthetic device is the only option. Careful planning needs to take place in order to ensure that the athlete arrives in the best shape for the day of the competition.

Addressing biomechanical needs

should start with addressing any muscle imbalance and ensuring a good

core stability and muscle strength in the back. Working with the prosthetics practitioner to ensure that the limb is appropriate for the athlete in terms of weight and function is equally important and should involve some of the more specialist practitioners who understand the rigors of competitive sport in relation to amputees.

VISUALLY IMPAIRED ATHLETES

Visually impaired athletes cross the boundaries from complete independence to high levels of dependency if completely blind. Although it is relatively easy to find one’s way around the familiar surroundings of home, travel to venues and hotels poses special challenges and is reflected in a higher incidence of lower extremity injuries as a consequence of falls in this group of athletes. Classification across the wide range of sports is via the International Blind Sports Federation (IBSA) classification system (12): n B1 (S11): from no light perception in either eye, up to light perception but inability to recognise the shape of a hand at any distance or direction. n B2 (S12): from ability to recognise the shape of a hand, up to visual acuity of 2/60 or visual field of less than 5°. n B3 (S13): from visual acuity above 2/60, up to visual acuity of 6/60 or a visual field of more than 5° but less than 20°.

CONSIDERATION WHEN TRAVELLING WITH DISABLED ATHLETES As a team doctor or physiotherapist, you may be called upon to advise on issues relating to travel abroad with a team of athletes with a disability. The normal preparations for travel with a team abroad are outside the scope of this article, but there are a number of factors that need to be addressed in order to ensure a successful trip.

sportEX medicine 2009;42(Oct):13-19