Spinal cord injuries

Spinal cord injuries usually result in paralysis or par­tial paralysis of the arms, trunk, legs, or any particular combination thereof depending on the locus of the damage. The spinal cord is housed in the spinal or vertebral column. Nerves from the spinal cord pass down into the segments of the spinal column. Injury to the spinal cord affects innervation of muscle. The higher up the vertebral column the level of injury, the greater the restriction of body movement. Per­sons with spinal cord injuries are usually referred to as paraplegics or quadriplegics. A paraplegic is one who has the legs paralyzed. The quadriplegic has both the arms and legs affected.

The physical fitness characteristics of persons with spinal cord injury have been suspected as being re­lated to the level of their lesion. Kofsky et al found significant differences between the aerobic power as predicted by submaximal ergometer tests between classifications of spinal column lesions at levels 2, 3, and 4. However, Winnick and Short, who studied children aged 10 to 17 who are classified as levels 2 to 5, found that when comparing skinfold measures, grip strength, arm-hand pullups, speed in the 50-yard dash and shuttle run, and distance in the Softball throw, significant differences were not found among levels nor ages. Collectively, the physical characteris­tics are as follows:

1. Inappropriate control of the bladder and diges­tive organs

2. Contractures (abnormal shortening of muscles)

3. Heterotopic bone formation, or laying down of new bone in soft tissue around joints (during this process the area may become inflamed and swollen)

4. Urinary infections

5. Difficulty in defecation

6. Spasms of the muscles

7. Spasticity of muscles that prevent effective movement

8. Overweight because of low energy expendi­tures

Therapeutic Treatment. Therapeutic treatment should be based on a well-rounded program of exercises for all the usable body parts, including activities to develop strength, flexibil­ity, muscular endurance, cardiovascular endurance, and coordination. Cardiovascular development may be attained through arm pedaling of a bicycle ergo­meter, pushing of a wheelchair over considerable distances, and agility maneuvers with the wheelchair. Paraplegics can perform a considerable number of physical activities.

Movement and dance therapies have been used successfully in rehabilitation programs for persons who have spinal cord injuries. Berrol and Katz indi­cate that the focus of outcomes was goal oriented and there was considerable similarity between dance therapy, movement therapy, and those activitites that traditionally are included in adapted physical educa­tion programs. Once treatment goals are established, the disciplines appear to conduct their programs in a very similar manner.

Paraplegics can perform most physical education ac­tivities from a wheelchair. For younger children, fundamental motor skills such as throwing, hitting, and catching are appropriate. Once these skills are mas­tered, games that incorporate these skills may be played. Modifications of games that have been previ­ously described are appropriate for children in wheelchairs. Children in wheelchairs can participate in parachute games and target games without accom­modation. They can maintain fitness of the upper body through the same type of regimens as do the nonhandicapped. Strengthening of the arms and shoulder girdle is important for propulsion of the wheelchair and for changing body positions when moving in and out of the wheelchair. Swimming is a particularly good activity for the development of total physical fitness.

Several organizations promote competition for persons in wheelchairs. These include archery, bowl­ing, basketball, table tennis, wheelchair racing, and track events. Classification systems based on the levels of injury and physical functioning ability have been developed for equitable competition.

AMPUTATIONS

Amputations can be classified into two categories – acquired amputation and congenital amputation. The amputation is acquired if one has a limb removed by operation; it is congenital if the child is born without a limb.

Congenital amputations are classified according to the site and level of limb absence. When an amputa­tion is performed through a joint, it is referred to as a disarticulation.

Medical Treatment. Medical treatment involves the design of a prosthetic appliance. The purpose of the prosthetic device is to enable the individual to function as normally as pos­sible. The application of a prosthetic device may be preceded by surgery to produce a stump..After the operation the stump is dressed and bandaged to aid shrinkage of the stump. Following the fitting of the prosthesis, the stump must be continually cared for. It should be checked periodically and cleaned to pre­vent infection, abrasion, and skin disorder.

The attachment of a false limb early in a child's development will encourage the incorporation of the appendage into natural body activity more than if the prosthesis is introduced later in life.

Prosthesis Training. Amputees must develop skill to use prostheses; effec­tive use demands much effort. Training should be di­rected toward daily living skills such as eating, drink­ing, dressing, and recreational skills that can be taught in physical education. Prostheses often result in problems of ambulation. These problems vary with the specific level of amputation.

Gait Training. Most gait deviations result from problems with the alignment of the prosthesis. Deviations may include rotations of the foot at heel strike, unequal timing, side walking base, abducted gait, excessive heel ride, instability of the knee, excessive knee flexion, hyper-extension of the knees, excessive pronation of the foot, foot slap, and rotation of the foot with continu­ing whip.

Persons with amputations below the knee can learn ambulation skills well with a prosthesis and training. Persons with amputation above the knee but below the hip may have difficulty in developing effi­cient walking gaits. Amputations at this level require alteration of the gait pattern. Steps are usually short­ened to circumvent lack of knee function.

Aids may be designed to assist prostheses of the legs or the arms. Assistive devices may be used to aid lo­comotion when the legs are debilitated. Some assis­tive devices are canes and crutches. A major problem for students who use canes and crutches is the need to learn balance to free one hand for participation in activity. Use of the Lofstrand crutches, which are an­chored to the forearms, enables balance to be main­tained by one crutch. This frees one arm and enables participation in throwing and striking activities.

Although it is difficult to substitute for the human hand and fingers, it is possible to achieve dexterity with the use of a utility arm and split hook. These aids enable the use of racquets for paddle games if both arms are amputated. Persons who have lost a single arm can play most basic skill games and partic­ipate in more advanced sports activity without modi­fications. Special devices can be built by an orthotist to fit into the arm prosthesis to hold sports equip­ment such as gloves.

Therapeutic Treatment. Amputees are often exposed to beneficial exercise through the use of the prosthesis. Exercises should be initiated to strengthen muscles after a stump heals. Training also enhances ambulation, inhibits atrophy and contractures, improves or maintains me­chanical alignment of body parts, and develops gen­eral physical fitness.

Authorities agree that children with properly fitted prostheses should engage in regular physical educa­tion activities. Amputees have considerable potential for participation in adapted sports and games. There are opportunities for persons with prostheses to par­ticipate in official sports competition.

There are several adaptations of physical activity that can be made for children with impaired ambu­lation. For these children the major disadvantages are speed of locomotion and fatigue to sustained activity. Some accommodations that can be made are short­ening the distance the player must travel and de­creasing the speed needed to move from one place to another.

Physical fitness of amputees should be an impor­tant part of a physical education program. Strength and flexibility and power of the unafflicted limbs are important. Furthermore, Lasko and Knorph stress the importance of developing and maintaining the amputees' level of cardiovascular efficiency.

Дата добавления: 2015-11-16