Università degli Studi di Messina

CORSO DI LAUREA SPECIALISTICA IN SCIENZE

E TECNICHE DELLE ATTIVITÀ MOTORIE
PREVENTIVE E ADATTATE

"Metodi e tecniche dell'attività motoria nella disabilità"

Medicina Fisica e Riabilitativa (MED 34)
Docente : Prof. ROBERTO DATTOLA
Choosing an activity or sport
The choice of sport will be influenced by various factors that include:

The personal preference of the person—an emphasis on

enjoyment and participation in a sport that stimulates the
person may be important for continued participation

The characteristics of the sport— physiological demands,

collision potential, team or individual, coordination
requirements

The medical condition —beneficial and detrimental

Conditions associated with the condition—although motor

dysfunction may initially appear to be the major limitation to
participation there may be for example an associated cardiac
condition to consider
Choosing an activity or sport

The cognitive ability and social skills of the person—

ability to follow rules and interact with others.

Availability of facilities

Availability of appropriate coaching and support staff—

for example, lifting and handling

Equipment availability and cost—as disability sport has

evolved, so has the technology. Specialist chairs are
available for sports such as tennis, rugby, and basketball.
Although sport specific chairs are not necessary for
initial participation it does become a consideration as
people develop their interest and feel more limited by
their equipment.
Risks of participation
In general terms there are relatively few absolute
contraindications to participation in physical activity for anybody,
able bodied or not, if the general training principles of gradual and
progressive overload are applied.

Cardiac conditions--Sudden deaths, associated with

vigorous exercise or sports participation, are
predominantly related to cardiac conditions. For people
with a disability it requires greater awareness from
their physician of conditions that may have associated
cardiac disease. Exercise intensity is an important
consideration in sport selection where cardiac
anomalies may be present--for example, Down's
syndrome
Risks of participation

Trauma--Sports may be classified by their risk for

collision potential (for example, skiing or cycling) or
they may be a contact sport such as football. Bone
mineral density may be reduced by the nature of the
condition--for example, osteogenesis imperfecta--or
secondary to immobilisation (for example, in
paraplegia) and the risk of spontaneous fracture or
fracture with minimal trauma exists. The risk of
atlantoaxial instability in people with Down's syndrome
remains an issue of contention
Risks of participation
Environmental issues--Risks of heat or cold injury may occur
due to loss of autonomic function in, for example, spinal cord
injury. People who have had both legs amputated will have reduced
surface area for evaporative cooling during exercise in a hot
environment

Overuse injuries--The potential for overuse injury

occurs in any athlete in regular training but there are
certain predisposing factors which are likely to be more
prevalent:

Biomechanical factors--for example, gait in cerebral

palsy or scoliosis in spina bifida

Technical factors--coordination difficulties or

restriction of movement altering correct technique.
Box 1: Sports of the Paralympic Games

Archery
Athletics
Basketball
Boccia
Cycling
Equestrian
Fencing
Football
Goalball
Judo
Powerlifting
Sailing
Shooting
Swimming
Table Tennis
Tennis
Volleyball
Wheelchair Rugby
Alpine skiing
Nordic skiing including biathlon
Ice sledge hockey
Spinal cord lesions
The motor loss that occurs after spinal cord injury
reflects the level of the lesion, but several other
factors should be considered:

Loss of intercostal muscle function with reduced

ventilatory capacity

Postural stability--scoliosis may require bracing for

some sports

Sensory loss--skin pressure--increased pressure and

shear forces from sports activities may increase the
risk of skin ulceration
Spinal cord lesions
Autonomic impairment: Bowels and bladder--It is
important that dehydration does not occur as this not
only impairs sport performance and risks heat illness
but also is likely to aggravate renal calculi and infection

Thermal regulation--loss of peripheral receptor

mechanism, control of the sweating effector
mechanism, and control of the ability to appropriately
vasoconstrict or vasodilate the peripheral vasculature.
In the cold environment the muscles will not shiver and
the skin responses are not appropriate and increase the
rate of heat loss
Spinal cord lesions
Cardiovascular--a spinal cord lesion above the level of
T1 will cause an absence of sympathetic cardiac
innervation producing a depressed maximal heart rate
and the level is determined by the intrinsic sino-atrial
activity (110-130 beats per minute)

Musculoskeletal injuries--data on the true incidence

and type of injury in people with spinal cord lesions are
limited. Chronic and overuse symptoms in the cervical
and thoracic spines and the shoulder are not uncommon,
as are traumatic injuries to the forearm, hand, and
fingers.
Spinal cord lesions
Autonomic dysreflexia--an inappropriate response
triggered by nociceptive input below the level of the
lesion producing hypertension, sweating, skin blotching,
and headache. The usual causes are blockage of a
urinary catheter, constipation, urinary calculi, anal
fissure or ingrowing toenail. It can produce severe
hypertension, cerebral haemorrhage, fits, and death
and as such is treated as a medical emergency with
treatment aimed at removing the nociceptive stimulus
and reduction of blood pressure with sublingual
nifedipine. A hazardous dysreflexic state is considered
to be present when the systolic blood pressure is 180
mm Hg or greater
Spina bifida
Depending on the level of the motor loss people may be ambulant or require
a wheelchair for activity. Those who are ambulant have relatively few
limitations in sport. Those with higher lesions are more prone to significant
scoliosis that may require bracing or spinal fusion. Contractures are
common and stretching and flexibility should be an important part of the
exercise programme. Bowel and bladder function and sensory loss may be
present but not the autonomic problems of the spinally injured.

Visually impaired
Visual impairment can range from complete blindness to partial sightedness
combining loss of visual acuity and field loss. Adaptations to sports include
a sound emitting ball for goalball or cricket or a tandem cycle with a
sighted pilot rider. In swimming, an assistant taps the head or shoulder of
the swimmer with a soft ended pole to indicate the pool end to enable
turning and finishing. Adaptations can be made to rifles to emit an audible
tone when on target. Cross country and alpine skiing events are possible
with guide skiers who give audible commands. The main problems specific to
the disability include falls and collisions causing injury.
Cerebral palsy
The three primary motor disorders that characterise the condition
are spasticity, choreoathetosis, or ataxia. Hypotonic cerebral palsy
is less common. Commonly associated disorders that should be
considered in sport selection include:

Epilepsy
Visual defects
Deafness
Intellectual impairment
Perceptual deficits
Speech impairment.

At élite level, half of competitors compete in a wheelchair and the

others are ambulant.
Amputees
Amputees may participate in sport with a prosthesis (for
example, sprinting or cycling) or without (for example,
high jump or swimming) or may compete in a wheelchair
(for example, basketball). The main risks to the residual
limb occur from the effects of friction and compression
when a prosthesis is used. Impact loading is also a
concern for the residual limb with increased ground
reaction forces that may lead to degenerative change in
joints higher in the kinetic chain. Technological advances
in prosthetic design may reduce this loading while
storing energy to facilitate propulsion.
Intellectual disability
Apart from intellectual disability, other terminologies often used are including
learning disability, mental handicap, mental deficiency, and mental retardation. They
all refer to the same condition. The International Paralympic Association and
International Sports Federation for Persons with Intellectual Disability diagnostic
criteria for intellectual disability require:

Significant impairment in intellectual functioning, as determined by

a rating that is two standard deviations below average on an
appropriate/recognized assessment instrument. (This generally an
IQ score of 75 or lower.)
Significant limitations in adaptive behaviour, as expressed in
conceptual, social, and practical adaptive skills. Examples of these
skills include communication, self care, self direction, and social and
interpersonal skills.
Intellectual disability must be evident during the developmental
period. This is generally considered to be from conception to 18
years of age.
International Paralympic Association rules require evidence that an
athlete's disability has significant sport related affects, which
makes it impossible for the athlete to compete "on reasonably equal
terms" with non-disabled athletes.
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