ATHLETES WITH DISABILITIES

is another common problem, often due to poor posture combined with trained over use of the medial rotators of the glenohumeral joint, poor scapular mechanics and the inability to rest the shoulders. This is a complex problem and best dealt with out of season or ideally prophylactically, with muscle conditioning and athlete education.

Cerebral palsy Cerebral palsy athletes may have associ- ated conditions such as epilepsy. In our experience, this may be found in those athletes with learning disabilities and up to 5% of the team may fit into this category. Having seizures in public places can be embarrassing and distress- ing for the athlete but in the cramped conditions of an aircraft, this is accentu- ated. It is also more difficult for the physician managing the situation to discretely administer rectal diazepam in an aircraft cabin. The effects of dehydra- tion may also increase the possibility of epileptic seizures.

Problems can relate to the timing of medications when crossing multiple time zones. The principles for minimising jet lag include synchronising with the desti- nation’s time when boarding the plane and this may result in temporary under or over administration of medication. With regard to anti-convulsant medication, it may be appropriate to err on the side of slight over-administration. It is clear from review of advice on the administra- tion of Insulin for diabetes that there are no hard and fast guidelines generally adopted by physicians when advising on adjustment of medications (11).

TABLE 3: PREVENTION OF MEDICAL PROBLEMS

■ Prior knowledge of athletes conditions ■ Education regarding dehydration

■ Encourage fluid intake in-flight ■ Provide adequate toilet assistance

■ Liaise with air carrier prior to departure ■ Elevation of legs where room ■ Take additional fluids on board ■ Take appropriate medications

■ Prophylactic aspirin administration

■ Encourage mobility where possible ■ Encourage relief of pressure areas ■ Education regarding new environment

Athletes with cerebral palsy usually demonstrate a degree of spasticity and it is important for physiotherapists working with these athletes to avoid automatically working to decrease the tone. It may be that the athlete uses their tone, for propulsion when competing and performance can be adversely affected by overzealous passive stretching.

Amputees Athletes with amputations may develop some oedema in the resid- ual limb, due to immobility during the flight. Limbs should be elevated and moved and pressure socks left on during the flight to ensure that the prosthesis will fit at the destination. Soreness of the weight bearing areas may develop due to long periods of standing and walking around airports. It is sensible for some athletes with high level amputations to consider whether the use of a wheelchair or crutches may be an option during travel to reduce stress on the residual limb.

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If travelling to extremely hot and humid climates it is important to be aware that high level amputees have less area to lose heat from and so may suffer more severely from the heat. On a purely practical note, prosthetic legs will set off walk-through xray machines and athletes may require to show their prosthesis to the security officers, so extra time should be allowed to get through security.

The most common injuries affecting this group are limb abrasions and spinal pain due to asymmetrical forces. It is best to avoid abrasions by fastidious stump care and appropriate rest, but thin skin preparations such as Second Skin or some of the blister dressings can work. Thick bulky dressings should be avoided at all costs as they simply worsen the problem. Although they are heavy, sports legs should be carried as hand luggage to avoid them being mislaid. Four went missing on a trip to Poland some years ago, resulting in players using their everyday legs to train, with disastrous results for the skin and the competition.

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