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Accommodations in Everyday Life

Accommodation in Sport

-Dependent on degree of injury

-Changing the sport for everyone

  • Sitting volleyball
  • Goalball

-Use of mobility aids

  • Wheelchair basketball
  • Sledge Hockey

- Ramps

- Elevators

- Accessible seating

- Automatic doors

- Adjustable desk and sink heights

- Priority seating on public transportation

Constraints & Barriers

Accommodations vs. Modifications

Impact on Physical Education

Tips to keep in mind when incorporating students with a SCI

Impact on Fitness and Risk Factors

Autonomic Dysreflexia

Accomodations

Modifications

  • Get to know your students and their abilities
  • Use appropriate adapted equipment
  • Provide a safe environment for each student
  • Provide the student with a variety of learning experiences
  • Use activities that are both challenging but achievable

A modification is a change in what was previously learned to produce the same outcome

  • In the physical education system, there is a lack of support for educators to properly include students with spinal cord injuries in general physical education.
  • Many students with an SCI have to deal with always being singled out in class or feeling isolated which may lead to feelings of isolation or embarrassment.

Respiratory Control

An accommodation is something that helps make the work easier and reduce the challenges and limitations created by a disability

Musculoskeletal Injury

Regulatory Systems During Exercise

Since our nervous system controls many regulatory systems in our bodies, if there is an injury in the spinal cord there needs to be extra precautions taken when exercising due to these listed risk factors.

1. Autonomic Dysreflexia: This occurs when there is a large spike in blood pressure due to a hyper response below the injured spinal cord where your body cant detect. (t2)

2. Musculature injuries: Overuse injuries in the upper extremities especially in the shoulder are common due to use of the same muscles for both everyday activities and exercise.

3. Thermal dysregulation: This is the result of the body not being able to regulate temperature due to the loss of blood vessel control and its sweating response (above or at t6).

4. Respiratory control: When there is an injury near the cervical or thoracic region, this will affect the transmission of nerve impulses down the spine to the diaphragm, which can alter it's function and affect breathing.

Individual Constraints

Thermal Dysregulation

Functional

Structural

Accomodations enable a person to meet curriculum expectations and modifications alter the curriculum expectations

Newall's Model

Causes and Progression

Impact on Recreational Activities

  • Primary cause results from
  • Falls
  • Sport injuries
  • Violence
  • Trauma from traffic accidents
  • Degenerative diseases

Impact on Sport

  • People with SCI reported a discontinuance in participation in several recreational activities after injury. The results of one study provided data that showed 40% of regular participants discontinued partaking in recreational sports after an SCI, followed by traveling (24%), social events (21.5%), and going to concerts or cinemas (19.6%).
  • All of the listed activities require the individual to have a basic level of motor control, a high level of self- independence and adequate mobility which may be impeded due to lack of accessibility in many of these recreations.
  • Wheelchair dependency often leads to a sedentary lifestyle so its very important that there is growing awareness and accessible opportunities for all to participate in physical activity

  • The benefits that an individual with an SCI can gain from sport participation will largely depend on the degree of effort that they are willing to put into the sport and the location of the injury.
  • It is important to use an individualized approach with SCI athletes as there are unique variables that may impact the persons ability to participate.
  • When there is a full loss of sensation and mobility below the waist (Paraplegia) or all 4 limbs (quadriplegia), it can be very difficult for that person to participate and keep up in traditional sports. Instead, there are great opportunities to participate in para sports such as wheelchair basketball or wheelchair rugby that are appropriately modified to create an even level of play.

  • There are 4 major mechanisms of injury:
  • Impact + persistent compression
  • Impact alone with transient compression
  • Distraction
  • laceration/transection

Environmental Constraints

Task Constraints

Benefits vs Barriers

  • Despite the many barriers present for this population when trying to participate in physical activity, the benefits should outweigh the barriers so its important to create an inclusive environment for all.
  • Since staying active can become difficult for people with SCI, many fall into the trap of continuous deconditioning.

Classifications

Examples:

  • Opportunity for socialization
  • Increased independence
  • Higher perceived quality of life
  • Weight maintenance
  • Atrophy prevention
  • Improved diaphragm function
  • Less pain
  • Improved cardiovascular health
  • Increased strength

Classified as either complete or incomplete

5 categories of SCI:

  • A= Complete- no preserved motor/sensory function below level of injury
  • B-D = incomplete- brain's ability to send signals below the site of the injury is not completely removed.
  • E= motor and sensory function after spinal cord injury (SCI)

Structural Constraints

Functional Constraints

  • Loss of strength or muscle weakness/atrophy
  • Loss of motivation
  • Lack of spatial awareness
  • Loss of sensory or motor function/sensation
  • Muscle spasms
  • Loss of bladder or bowel control
  • Difficulty breathing

Task Constraints

Depending on the spinal cord lesion level

  • paraplegia
  • sensory and motor functions of the lower body are impaired.
  • tetraplegia/ quadriplegia
  • impaired sensory and motor functions in all 4 limbs

Modifications in Sport

  • Feeling singled out or isolated in group settings
  • Non inclusive language and instructions
  • E.g, using the phrase "run" instead of "move"

-Dependent on severity and degree of injury

-Setting up smaller obtainable goals (chunking)

-Example of wheelchair basketball

  • Chair with higher back to stabilize torso
  • use hand/wrist splints to assist with grip strength and stability
  • softer playing area avoiding surfaces like concrete and sand
  • lighter ball/equipment

Spinal Cord Injury

Environmental Constraints

  • Inaccessibly designed public spaces
  • Limited access to ramps, elevators, automatic doors, accessible washrooms and parking
  • Attitudinal barriers
  • Discriminatory assumptions or misconceptions formed

Stacie, Carina, Matthew, Cory, Papilash, Taya

  • damage to spinal cord
  • damage to nerves, aka cauda equina
  • permanently affects person's strength, feeling, and other body functions
  • one experiences mental, emotional, and social side effects
  • two factors in which ability to move body depends
  • the location
  • the severity

Overview of Spinal Cord Injuries

References

Ali, Z.S., Whitmore, R.G. (2016). Spinal Cord Injuries. In: O'Donnell, J., Nácul, F. (eds) Surgical Intensive Care Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-19668-8_16

MS;, J. P. (n.d.). Exercise recommendations for individuals with Spinal Cord Injury. Sports medicine (Auckland,

N.Z.). https://pubmed.ncbi.nlm.nih.gov/15456347/

Jacobs, P. L. (n.d.). Examining the continuity of recreation engagement in individuals with ... https://www.researchgate.netpublication/290126880_Examining_the_continuity_of_recreation_engagement_in_individuals_with_spinal_cord_injuries

Sports for individuals with Spinal Cord Injury. Physiopedia. (n.d.). https://www.physio-pedia.com/Sports_for_Individuals_with_Spinal_Cord_Injury#:~:text=Participation%20in%20Sport%20for%20Spinal%20Cord%20Injury,-Despite%20the%20many&text=Activity%2DBased%20Therapies%20effectively%20promote,adults%20and%20children%20post%2DSCI.

Fitness after SCI: How to Get Started. Fitness after Sci: How To Get Started. (n.d.). https://sci.washington.edu/info/newsletters/articles/04fall_fitness.asp

Charrette, P. (2023, January 16). Adapted physical education wheelchair activities: 25 fun and engaging movement experiences for pe. capnpetespowerpe. https://www.capnpetespowerpe.com/single-post/adapted-physical-education-wheelchair-activities-25-fun-and-engaging-movement-experiences-for-pe

Making Sport More Inclusive for People With a Spinal Cord Injury

-Give the equivalent level of respect to everyone

-Be empathetic towards everyone

-Always ask before moving assistive devices

-Provide modifications

-Don't assume what is possible and what isn't for them

-Be patient

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