Page 817 of 897
Previous Page     Next Page        Smaller fonts | Larger fonts     Go back to the flash version

ASSESSMENT AND MANAGEMENT

skill is likely to have used different cues to those that might be expected.

It helps to try and understand the feedback that the athlete may be using to refine his movements. Whilst an athlete may have lost sensation, he/she adopts feedback from other avenues to gain an appreciation of movement eg. this may be the feel of stretch in another part of the body which is not directly involved in the movement. You will need to reflect on your own teaching skills at this point as you may need to adapt your usual verbal cues and explanations as they may not be relevant!

It follows then that translating able-bodied activities into a sitting position, for example, for a wheelchair user, isn’t quite enough, so you will need to ask the athlete for help and more detail. Generally this comes over as a very positive enquiry, and the athlete is delighted to respond to your interest and explain. This can often build a very positive problem-solving approach and a fruitful therapeutic relationship.

USE OF THE MULTI-DISCIPLINARY TEAM In sport an athlete can be surrounded by a wide variety of profes- sionals from coaching, sports science and sports medicine back- grounds. In disability sports this group may be extended with the inclusion of an additional support team which includes orthotists or prosthetists, wheelchair technicians, sports assistants (eg. a tandem rider in cycling), nurses or carers. Communication with, and between key members of the multi-disciplinary team is therefore crucial for success, as it is very easy for influential members to inadvertently conflict.

MAINTENANCE OF GENERAL FITNESS General fitness can be difficult to maintain for the athlete with a

Figure 2: A power-assisted hand bike upgraded for rough terrain use

disability (4) and often problems are related to access to facilities eg. gyms and swimming pools.

While gyms usually now provide

dedicated parking and have ramp access into their facilities, too frequently only a limited amount of exercise equipment is useable. For instance, it can be hard for a wheelchair user to do an adequate cardio-vascular workout as bikes, rowers and steppers are not available to them.

To address these omissions the athlete with a disability and in particular the wheelchair user, will often try to instigate general fitness work at home. A range of exercise options are available such as hand cycling (figure 2), push training (in the wheelchair) on the pavement or a rolling road, hand-cranking or pulley systems. Some of these options however, present other problems, which influence regular usage.

EQUIPMENT No special equipment is needed to treat athletes with a disability,

A CASE EXAMPLE Recurrent sprained ankle in a table tennis player with cerebral palsy Player B has left sided hemiplegia. She is in her late teens and is ambulant without mobility aids. She competes on her feet. Increased tone makes it difficult for her to weight bear through her left foot. Exertion increases this tone.

Considerations for your management plan:- Inclusion of techniques to facilitate changes in tone of the lower limb and the trunk Inclusion of exercises to gain trunk elongation and rotation Isolation or control of specific movements in relation to the sporting activity How is the left arm assisting balance and helping to generate force for her strokes/shots? Facilitation of weight bearing through the left side when standing and through weight transference at normal walking speeds and direction (everyday activities)

Facilitation of weight bearing and weight transference through the left side during match play at speeds and directions used in the sport

Progress to use forehand, backhand, serve and integrate these into sequences appropriate to training and match play Improve performance by developing core control awareness and controlled movement patterns Re-train some movement patterns but be aware that the athlete may be using high tone to function. Reduction of tone may lead to reduced performance

Use of splints/braces may be appropriate, but be mindful of their impact on other aspects of function, and of the rules of the sport and potential impact on the athlete’s sport classification.

Symmetry and 'normal' function is often unrealistic so be prepared to be open-minded Be innovative and creative, but keep clear goals in mind Regularly reassess the value of your interventions Focus on ability not disability.

8 sportEX medicine 2007;32(Apr):6-9

Previous arrowPrevious Page     Next PageNext arrow        Smaller fonts | Larger fonts     Go back to the flash version
1  |  2  |  3  |  4  |  5  |  6  |  7  |  8  |  9  |  10  |  11  |  12  |  13  |  14  |  15  |  16  |  17  |  18  |  19  |  20  |  21  |  22  |  23  |  24  |  25  |  26  |  27  |  28  |  29  |  30  |  31  |  32  |  33  |  34  |  35  |  36  |  37  |  38  |  39  |  40  |  41  |  42  |  43  |  44  |  45  |  46  |  47  |  48  |  49  |  50  |  51  |  52  |  53  |  54  |  55  |  56  |  57  |  58  |  59  |  60  |  61  |  62  |  63  |  64  |  65  |  66  |  67  |  68  |  69  |  70  |  71  |  72  |  73  |  74  |  75  |  76  |  77  |  78  |  79  |  80  |  81  |  82  |  83  |  84  |  85  |  86  |  87  |  88  |  89  |  90  |  91  |  92  |  93  |  94  |  95  |  96  |  97  |  98  |  99  |  100  |  101  |  102  |  103  |  104  |  105  |  106  |  107  |  108  |  109  |  110  |  111  |  112  |  113  |  114  |  115  |  116  |  117  |  118  |  119  |  120  |  121  |  122  |  123  |  124  |  125  |  126  |  127  |  128  |  129  |  130  |  131  |  132  |  133  |  134  |  135  |  136  |  137  |  138  |  139  |  140  |  141  |  142  |  143  |  144  |  145  |  146  |  147  |  148  |  149  |  150  |  151  |  152  |  153  |  154  |  155  |  156  |  157  |  158  |  159  |  160  |  161  |  162  |  163  |  164  |  165  |  166  |  167  |  168  |  169  |  170  |  171  |  172  |  173  |  174  |  175  |  176  |  177  |  178  |  179  |  180  |  181  |  182  |  183  |  184  |  185  |  186  |  187  |  188  |  189  |  190  |  191  |  192  |  193  |  194  |  195  |  196  |  197  |  198  |  199  |  200  |  201  |  202  |  203  |  204  |  205  |  206  |  207  |  208  |  209  |  210  |  211  |  212  |  213  |  214  |  215  |  216  |  217  |  218  |  219  |  220  |  221  |  222  |  223  |  224  |  225  |  226  |  227  |  228  |  229  |  230  |  231  |  232  |  233  |  234  |  235  |  236  |  237  |  238  |  239  |  240  |  241  |  242  |  243  |  244  |  245  |  246  |  247  |  248  |  249  |  250  |  251  |  252  |  253  |  254  |  255  |  256  |  257  |  258  |  259  |  260  |  261  |  262  |  263  |  264  |  265  |  266  |  267  |  268  |  269  |  270  |  271  |  272  |  273  |  274  |  275  |  276  |  277  |  278  |  279  |  280  |  281  |  282  |  283  |  284  |  285  |  286  |  287  |  288  |  289  |  290  |  291  |  292  |  293  |  294  |  295  |  296  |  297  |  298  |  299  |  300  |  301  |  302  |  303  |  304  |  305  |  306  |  307  |  308  |  309  |  310  |  311  |  312  |  313  |  314  |  315  |  316  |  317  |  318  |  319  |  320  |  321  |  322  |  323  |  324  |  325  |  326  |  327  |  328  |  329  |  330  |  331  |  332  |  333  |  334  |  335  |  336  |  337  |  338  |  339  |  340  |  341  |  342  |  343  |  344  |  345  |  346  |  347  |  348  |  349  |  350  |  351  |  352  |  353  |  354  |  355  |  356  |  357  |  358  |  359  |  360  |  361  |  362  |  363  |  364  |  365  |  366  |  367  |  368  |  369  |  370  |  371  |  372  |  373  |  374  |  375  |  376  |  377  |  378  |  379  |  380  |  381  |  382  |  383  |  384  |  385  |  386  |  387  |  388  |  389  |  390  |  391  |  392  |  393  |  394  |  395  |  396  |  397  |  398  |  399  |  400  |  401  |  402  |  403  |  404  |  405  |  406  |  407  |  408  |  409  |  410  |  411  |  412  |  413  |  414  |  415  |  416  |  417  |  418  |  419  |  420  |  421  |  422  |  423  |  424  |  425  |  426  |  427  |  428  |  429  |  430  |  431  |  432  |  433  |  434  |  435  |  436  |  437  |  438  |  439  |  440  |  441  |  442  |  443  |  444  |  445  |  446  |  447  |  448  |  449  |  450  |  451  |  452  |  453  |  454  |  455  |  456  |  457  |  458  |  459  |  460  |  461  |  462  |  463  |  464  |  465  |  466  |  467  |  468  |  469  |  470  |  471  |  472  |  473  |  474  |  475  |  476  |  477  |  478  |  479  |  480  |  481  |  482  |  483  |  484  |  485  |  486  |  487  |  488  |  489  |  490  |  491  |  492  |  493  |  494  |  495  |  496  |  497  |  498  |  499  |  500  |  501  |  502  |  503  |  504  |  505  |  506  |  507  |  508  |  509  |  510  |  511  |  512  |  513  |  514  |  515  |  516  |  517  |  518  |  519  |  520  |  521  |  522  |  523  |  524  |  525  |  526  |  527  |  528  |  529  |  530  |  531  |  532  |  533  |  534  |  535  |  536  |  537  |  538  |  539  |  540  |  541  |  542  |  543  |  544  |  545  |  546  |  547  |  548  |  549  |  550  |  551  |  552  |  553  |  554  |  555  |  556  |  557  |  558  |  559  |  560  |  561  |  562  |  563  |  564  |  565  |  566  |  567  |  568  |  569  |  570  |  571  |  572  |  573  |  574  |  575  |  576  |  577  |  578  |  579  |  580  |  581  |  582  |  583  |  584  |  585  |  586  |  587  |  588  |  589  |  590  |  591  |  592  |  593  |  594  |  595  |  596  |  597  |  598  |  599  |  600  |  601  |  602  |  603  |  604  |  605  |  606  |  607  |  608  |  609  |  610  |  611  |  612  |  613  |  614  |  615  |  616  |  617  |  618  |  619  |  620  |  621  |  622  |  623  |  624  |  625  |  626  |  627  |  628  |  629  |  630  |  631  |  632  |  633  |  634  |  635  |  636  |  637  |  638  |  639  |  640  |  641  |  642  |  643  |  644  |  645  |  646  |  647  |  648  |  649  |  650  |  651  |  652  |  653  |  654  |  655  |  656  |  657  |  658  |  659  |  660  |  661  |  662  |  663  |  664  |  665  |  666  |  667  |  668  |  669  |  670  |  671  |  672  |  673  |  674  |  675  |  676  |  677  |  678  |  679  |  680  |  681  |  682  |  683  |  684  |  685  |  686  |  687  |  688  |  689  |  690  |  691  |  692  |  693  |  694  |  695  |  696  |  697  |  698  |  699  |  700  |  701  |  702  |  703  |  704  |  705  |  706  |  707  |  708  |  709  |  710  |  711  |  712  |  713  |  714  |  715  |  716  |  717  |  718  |  719  |  720  |  721  |  722  |  723  |  724  |  725  |  726  |  727  |  728  |  729  |  730  |  731  |  732  |  733  |  734  |  735  |  736  |  737  |  738  |  739  |  740  |  741  |  742  |  743  |  744  |  745  |  746  |  747  |  748  |  749  |  750  |  751  |  752  |  753  |  754  |  755  |  756  |  757  |  758  |  759  |  760  |  761  |  762  |  763  |  764  |  765  |  766  |  767  |  768  |  769  |  770  |  771  |  772  |  773  |  774  |  775  |  776  |  777  |  778  |  779  |  780  |  781  |  782  |  783  |  784  |  785  |  786  |  787  |  788  |  789  |  790  |  791  |  792  |  793  |  794  |  795  |  796  |  797  |  798  |  799  |  800  |  801  |  802  |  803  |  804  |  805  |  806  |  807  |  808  |  809  |  810  |  811  |  812  |  813  |  814  |  815  |  816  |  817  |  818  |  819  |  820  |  821  |  822  |  823  |  824  |  825  |  826  |  827  |  828  |  829  |  830  |  831  |  832  |  833  |  834  |  835  |  836  |  837  |  838  |  839  |  840  |  841  |  842  |  843  |  844  |  845  |  846  |  847  |  848  |  849  |  850  |  851  |  852  |  853  |  854  |  855  |  856  |  857  |  858  |  859  |  860  |  861  |  862  |  863  |  864  |  865  |  866  |  867  |  868  |  869  |  870  |  871  |  872  |  873  |  874  |  875  |  876  |  877  |  878  |  879  |  880  |  881  |  882  |  883  |  884  |  885  |  886  |  887  |  888  |  889  |  890  |  891  |  892  |  893  |  894  |  895  |  896  |  897