SPORTS CARE

Visually impaired athletes Visually impaired athletes may be in a situation where they have had to leave their guide dog behind and so feel very vulnerable due to their loss of independence. It will take a while for them to acquaint themselves with their new environment in the accom- modation, training and eating areas. During this time it is impor- tant for management to ask whether any assistance is needed and if so, ask how the athlete prefers to be assisted. Often they will simply wish to hold your elbow, do remember that they will be positioned slightly to your side and so you must allow extra room to negotiate obstacles. Remember to tell the athlete when there is a step or an obstacle to overcome. Minor injuries do occur in this group from stumbling or tripping in a strange environment or banging their head on low ceilings but otherwise there does not seem to be any increased risk of medical complications.

Les Autres The ‘Les Autres’ group of athletes encompasses those athletes who do not fit into any of the traditional disability categories and may include conditions such as multiple sclerosis, muscular dystrophy and a variety of congenital disorders. There is a tendency for a number of athletes to be in the team who have rare congenital disorders. Although it is the physical disability or limitation that is most apparent and restricts their sporting activity, it is the associated medical conditions that usually cause the problems. It is important for the medical team accompanying a group of ath- letes with disabilities to profile them prior to travel. This allows research of rare and complex conditions and also identifies any unusual medications that may be being used.

OTHER CONSIDERATIONS In addition to the medical complications that may occur as a result of long haul air travel, there are a number of other factors which make the process of travelling with the team more difficult and tiring. Although the Air Carrier Access Act states that no air carrier should discriminate against anyone with a disability, there are general considerations of accessibility within the airport and the aircraft to doorways, ramps and toilets that need to be con- sidered (12). Checking in is generally requested an hour earlier than normal and boarding also. This adds to the long procedure already established and means that athletes with disabilities are first onto the aircraft and last off. The staff accompanying the team should also be considered for medical complications, partic- ularly as they may have variable health and fitness levels.

CONCLUSION The key factor for medical personnel travelling with a team of ath- letes with disabilities is preparation. It is important to know the athletes, their conditions and their medications. This will pre- warn the physician of the potential problems that may occur and they may equip their medical bag appropriately. It is also impor- tant to educate athletes prior to embarking on travel particularly regarding dehydration and environmental considerations. Communication with the airline by the management team should clearly state the number of athletes with disabilities, particularly regarding wheelchair users who require assistance. This allows the airline to provide adequate staff. It is important to ensure that there is appropriate transportation at the destination as the load- ing time onto buses unsuitable for wheelchair use is an unwel- come problem after a long haul flight. On arrival at the destina-

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tion at risk patients should be checked for potential complications and urine should be checked for signs of dehydration either by visual inspection of colour, specific gravity or by osmolality if available. Checking of urine over subsequent days can monitor the hydration status that is particularly important when entering a thermally challenging environment. The medical team must remain vigilant for the potential consequences of air travel that may exclude an athlete from competition on arrival at their des- tination and prepare themselves appropriately.

THE AUTHORS ■ Kirsty Arbuthnott Røed MSc MCSP MMACP was chartered physio- therapist to the GB Disabled Volleyball and Wheelchair Basketball teams between 1992-2000 and has travelled extensively with ath- letes with a disability. She was honorary physiotherapist at the 1996, 1998 and 2000 Paralympic Games and the last three Commonwealth Games and is also a member of the Manipulation Association of Chartered Physiotherapists (MMACP).

■ Dr Nick Webborn is medical adviser to the British Paralympic Association and a member of the International Paralympic Committee Medical Commission, Anti-Doping Subcommittee and the Sport Science and Education Subcommittee. He has worked with athletes with disabilities since 1992 providing team care for a vari- ety of sports. He was medical officer for the Great Britain Paralympic teams at the Atlanta, Nagano and Sydney Paralympic Games and attended the 2002 Paralympic Games in Salt Lake City on behalf of the IPC.

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