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Spinal Cord Injury




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Table of Contents


      Information: Pages 3-5

        Websites: Pages 6-9

   Article Reviews: Pages 10-13

    Organizations: Pages 14-17

  Teaching Strategies: Pages 18-19

    Activity Description: 20-21




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                                           Information

       A spinal cord injury can be defined as the disruption of communication between the brain

and additional sections of the body. The extent of trauma to the spinal cord is reliant on the

severity and location of the injury. Because messages no longer have the capacity to flow

beyond the damaged region, the end result is a loss of or impaired functioning which initiates a

decrease in mobility or sensation.

       There are two categories of spinal cord injuries, complete and incomplete. The first type,

complete, signifies an injury in which there is no sensation or voluntary movement beneath the

damaged area of the spine. Characterized by limited functioning below the damaged spine, an

individual with an incomplete spinal cord injury may retain increased mobility in one limb rather

than the other or have feeling in areas of the body which have no movement.

       Additionally, quadriplegia is a term used to describe the most severe spinal cord injury.

Quadriplegics injuries occur between the first cervical vertebrae down through the first thoracic

vertebrae, affecting all four limbs. Paraplegia, a less severe yet devastating injury, refers to the

state in which the lower limbs are primarily affected.

       According to the National Spinal Cord Injury Association in 2003, ranked first among

major causes of spinal cord injuries was automobile accidents, accounting for forty-four percent.

Furthermore, twenty-four percent were caused by acts of violence; twenty-two percent were the

result of falls; eight percent were the result of athletic injuries; and the remaining two percent the

result of other accidents.

       Other characteristics of individuals afflicted with a spinal cord injury include autonomic

dysreflexia, pressure sores, spasticity, difficulties with thermoregulation, and respiratory

complications. Autonomic dysreflexia occurs in individuals with an injury above the sixth



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thoracic vertebrae. This complication initiates an increase in heart rate and blood pressure to

unsafe levels. Autonomic dysreflexia can be activated by numerous factors which include

expanding pressure from an overfull bladder or bowel, restrictive clothing, and pressure sores.

Left untreated, this condition may become life-threatening.

          Decubitus ulcers, more commonly referred to as pressure sores, a condition from which

the late Christopher Reeve suffered, is characterized by a lack of blood supply to the tissue

beneath the skin. A person remaining in the same position for a prolonged period of time

triggers tissue breakdown. Because trauma to a person’s spinal cord prevents messages from

accessing the brain, a person is unable to feel the tenderness which would typically initiate a

change in position. Left unchecked or untreated, pressure sores can lead to infection,

amputation, and even death.

          A third characteristic of individuals with spinal cord injuries is spasticity. This condition

is an involuntary exaggeration of normal reflexes when the body is stimulated in particular ways.

Triggering such spasms include stretching of muscles or irritation of some sort below the level of

injury.

          Individuals with spinal cord injuries also experience difficulties with thermoregulation,

regulation of the body’s internal temperature in response to the external environment. Because

these individuals have lost the capability to sweat, their internal temperature quickly changes in

response to the temperature of the external environment. Without close watch, these individuals

may become overheated or even hypothermic.

          Lastly, persons with spinal cord injuries often experience respiratory complications.

When a spinal cord injury affects the thorax, complications in normal breathing patterns become

the result. Because these muscles in the thoracic region are impacted as a result of the injury,




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these individuals have difficulty coughing which predisposes them to a higher risk of acquiring

pneumonia.

                                           References

Kelly, L. E. (2005). Spinal cord disabilities. In J. P. Winnick (Ed.), Adapted physical education

       and sport (pp. 275-305). Illinois: Champaign.

Paralyzed Veterans of America. (2006). Spinal Cord Injury. Retrieved December 1, 2006, from

       http://www.pva.org/site/PageServer?pagename=homepage




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                                              Websites

                   http://www.pecentral.com/adapted/factsheets/spinalcord.htm

                                     Retrieved December 1, 2006

        The first website which focuses on spinal cord injuries is PE Central. This website

provides a disability fact sheet specific to spinal cord injuries. This site first provides a

definition of the disability, and then continues with a comprehensive overview of the condition.

With headings and sub-headings, this website is constructed in an easily readable format so as to

quickly identify the pertinent information when searching for specifics.

        PE Central provides general information regarding spinal cord injuries such as

characteristics, causes, etiology and prognosis, as well as possible complications associated with

the disease. More importantly, this website provides a great deal of information applicable to

teaching physical education to a student with a spinal cord injury through a chart with functional

goals specific to the level of a complete spinal cord injury, implications for physical education,

and recommended activities.

        Towards the bottom of the website, PE central provides a list of references and resources

relevant to the topic. A colorful diagram of the vertebral column is the lone illustration on this

website. This illustration easily depicts the four sections of the vertebrae through the use of four

separate vibrant colors. In addition, it labels each vertebra and provides its function. For

example, T7 through T11 control the abdominal muscles.

        The second half of this page provides significant information relative to teaching physical

education to a student with a spinal cord injury. Provided are suggestions for physical education,

including important safety considerations and the importance of exercise. Under recommended

activities, it offers a variety of aerobic exercises, strength training exercises, and flexibility



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training exercises. Overall, this website as a whole is beneficial to persons wanting to gain an

understanding of a spinal cord injury and is specific to individuals with spinal cord injuries and

their participation in physical education.




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                        http://www.twu.edu/INSPIRE/Fact_Sheets/sci.htm

                                   Retrieved December 1, 2006

       The second website, which similar to PE Central provides a disability information sheet

specific to spinal cord injury, is also a valuable electronic resource. Following the general

summary of what constitutes a spinal cord injury is a list of hyperlinked references. These

references pertain to spinal cord injury on a large scale. Additionally, listed at the bottom of the

website are several links to numerous sport associations, for example, National Wheelchair

Basketball Association, American Wheelchair Bowling Association, National Wheelchair

Softball Association, and many more.

       Similar to PE Central, this website does not offer superfluous pictures or illustrations;

however, the few that are shown should be recognized. There are four illustrations scattered

throughout the website which are colorful cartoon representations of people participating in

various sports with the use of a wheelchair. One character is backhanding a tennis ball, another

participating in archery, another in basketball, and the last participating in road or long distance

racing. Although these may seem trivial, these illustrations portray the reality that people with

spinal cord injuries can too participate in the numerous physical activities with few

modifications.

       With regard to information useful in teaching physical education to a student with a

spinal cord injury, this webpage, and those directly linked are extremely useful. When scrolling

through the webpage, a section labeled “Adapted Sports and Recreation” is provided. Beneath

this section are several sports which offer techniques in modifying the sport in order for

individuals with spinal cord injuries to successfully partake in the excitement of these physical




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activities. For example, a modification which allows quadriplegics to participate in table tennis

includes taping or strapping the paddle to the individual’s hand.

       Although a variety of the sports do not provide modifications, hyperlinked directly under

the sub-heading are the association websites which correlate with the particular sport. Here an

individual is able to view the official rules of the chosen sport, which may conceivably initiate

one’s own ideas as to the way the sport can be modified or adapted to their own physical

education class. By and large, this website which focuses on spinal cord injury and sport is

especially beneficial.




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                                         Article Reviews

       As a result of reading “Spinal Cord Injury Patients Often Succumb to Bed Sores”

published in USA Today, three concepts were learned regarding the assigned disability of spinal

cord injury.

       The first concept learned, Concept A, is the severity of the pressure sores, a secondary

complication affecting individuals with spinal cord injuries. Of the 250,000 people living in the

United States with spinal cord injuries, greater than one-third of these individuals develop

pressure sores. Moreover, 60,000 Americans, approximately eight percent of those with spinal

cord injuries, die per year from complications stemming from pressures sores. This statistic is

twice the amount of those who die from prostate cancer. Even for individuals who receive top

treatment, pressure sores can be difficult to prevent.

       When the body presses on a vulnerable area and restricts blood supply, pressure sores are

initiated. Within hours, tissue can die. Sepsis, an infection developed when bacteria spreads to

the blood from an infected pressure sore, is fatal in at least half of the incidences.

       The second concept learned, Concept B, is Christopher Reeve’s struggle with his spinal

cord injury. In October of 2004, the Man of Steel died at the age of 52 due to a system-wide

infection, the result of a pressure sore. The infection eventually led to heart failure and a coma.

Following his 1995 accident, Christopher Reeve fought numerous life-threatening difficulties

which included “bone fractures, pneumonia, blood clots, a collapsed lung, repeated

hospitalizations and dozens of infections, including an infected ankle that could have led to

amputation.”

       In 1999, at Washington University in St. Louis, Reeve began an “activity-based

recovery” program. Assisting Reeve in exercising was a specialized bicycle and electrical



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stimulation. As a result of Reeve’s three years of rehabilitation, his muscles strengthened, his

osteoporosis disappeared, and the incidence of infection decreased by ninety percent.

Christopher Reeve, a quadriplegic, regained feeling in a majority of his body and recovered

minimal use of his extremities.

       The last concept learned, Concept C, is risk reducers and important advances with regard

to pressure sores. While pressure sores cannot be prevented, proper nutrition and diets with

sufficient protein are said to lessen one’s risk for developing pressure sores. Furthermore,

shifting a person’s weight when seated in a wheelchair will release pressure in areas susceptible

to pressure sores.

       Important gains are said to have been made relating to spinal cord injury. Urinary tract

infections resulting in kidney failure and death are now rare. Steroid injections can decrease

damage following spinal cord injuries. Lastly, hospitals are moving forward in preventing

deaths from sepsis.

                                            References

Szabo, L. (2004, October 24). Spinal cord injury patients often succumb to bed sores. USA

       Today.




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        As a result of reading “Quad Rugby: A Strength and Conditioning Program for the Elite

Athlete,” published in Strength and Conditioning Journal in August of this year, three concepts

were learned regarding the assigned disability of spinal cord injury.

        The first concept learned, Concept A, is the popularity of disabled sports, more

specifically quad rugby, and an understanding of the concept behind this wheelchair sport. Three

Canadians originated quad rugby, also referred to as wheelchair rugby, or murderball. In 1981,

quad rugby came to the United States. Developed to endorse and standardize the sport, was the

United States Quad Rugby Association in 1988. Quad rugby is characterized as being the fastest

growing wheelchair sport, and is an international event.

        In order to be eligible for participation in quad rugby, individuals must have a mixture of

both upper and lower extremity injury. Participants are organized into one of seven categories

and given a specified number of points depending on the severity of their impairment. Four

players are allowed on the playing court at once, with a maximum of eight points. Quad rugby is

performed on a basketball court, with players scoring by passing or carrying the ball across the

end line. Depending on one’s physical limitations, a selection of methods are used to pass the

ball, which are comprised of the one handed pass, two handed pass, or punching at the ball.

Players use their wheelchairs on defense to obstruct opponents and collide into them in an effort

to free the ball.

        The second concept learned, Concept B, is the astounding level at which quad rugby is

played. As a result of escalating competition, the physical stresses placed on quad rugby

participants have been lifted to a new level. The objective of preseason training is to improve

one’s overall strength and conditioning. This can be achieved through flexibility, strengthening,

plyometrics, and endurance training. Preseason training includes a five-day schedule with the




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remaining two days off for recovery purposes. The training schedule includes three strength

sessions, and two plyometrics and cardiovascular sessions per week.

       In-season training for quad rugby varies from the off-season with focus shifting from

conditioning towards technical skill. In-season training, similar to the preseason, includes a five-

day schedule with the remaining two days off for recovery purposes. In relation to preseason,

there is one less strength-training session with the addition of three skills sessions per week.

       The third concept learned, Concept C, is the needs of athletes with spinal cord injuries are

met with the execution of the same fundamental concepts as exercised by able-bodied athletes.

This exercise program is intended to increase flexibility, strength, and endurance of a quad rugby

participant who endures a spinal cord injury. However, after perusal of the article and the

descriptions of countless exercises, noticeable was the similarity between the exercises

performed by quad rugby athletes and those learned in Kinesiology intended for able-bodied

individuals.

                                             References

Gulick, D., Berge, B., Borger, A., Edwards, J., Rigterink, J. (2006). Quad rugby: A strength and

       conditioning program for the elite athlete. Strength and Conditioning Journal, 28, 10-18.




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                                         Organizations

                                  Paralyzed Veterans of America
                                    801 Eighteenth Street, NW
                                   Washington, DC 20006-3517

       The first organization which focuses on spinal cord injury is Paralyzed Veterans of

America. The purpose of this organization is to capitalize on the value of life for members and

all individuals affected with a spinal cord injury. Paralyzed Veterans of America is a primary

promoter for health care, research and instruction, veterans’ benefits and rights, accessibility and

the elimination of architectural obstacles, sports programs, and disability rights.

       More specifically, Paralyzed Veterans of America presents each year the National

Veterans Wheelchair Games, the world’s largest annual wheelchair sports competition. It is

here, throughout the week, where more than five hundred veterans, athletes with novice and

experienced abilities, recognize their capabilities and potential while taking pleasure in the spirit

of healthy activity and camaraderie.

       The 27th National Veterans Wheelchair Games will take place in June, 2007 in

Milwaukee, Wisconsin. Contestants will participate in a variety of games, all of which include:

9-ball, air guns, archery, basketball, bowling, handcycling, motorized wheelchair rally, power

soccer, power 220, powerchair relay, quad rugby, softball, swimming, table tennis, track and

field, weightlifting, and wheelchair slalom.

       The purpose of the National Veterans Wheelchair Games is to provide veterans with

benefits to the mind, body, and spirit. Paralyzed Veterans of America is committed to

encouraging veterans to become aware of their aptitude, fostering better health through sports

competition, and revitalizing the spirit of competition. Since the annual National Veterans




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Wheelchair Games began in 1981, thousands of veterans affected by spinal cord injuries have

benefited from their participation in sports.




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                           The National Spinal Cord Injury Association
                                  6701 Democracy Boulevard
                                          Suite 300-9
                                     Bethesda, MD 20817

       The second organization which focuses on spinal cord injury is The National Spinal Cord

Injury Association, NSCIA. As the nation’s oldest and largest civilian association, it is devoted

to improving the excellence of life for thousands of Americans affected by spinal cord injuries,

as well as their families. Founded in 1948, the NSCIA answers thousands of calls and e-mails

and provides information and referrals to individuals; provides peer assistance programs across

the country, connecting people with spinal cord injuries to one another; publishes and distributes

SCI Life magazine; works with partners to prevent violently acquired spinal cord injury; and

supports lawmaking proposals concerning issues affecting individuals with spinal cord injury.

       The National Spinal Cord Injury Associations mission is the following:

               “Enable people with spinal cord injury and disease to achieve their highest level

               of independence, health, and personal fulfillment by providing resources,

               services, and peer support.”

       The National Spinal Cord Injury Association offers an A-Z resource center. Found here

are virtually all subjects with any correlation to spinal cord injuries. Furthermore, there are lists

of fact sheets which provide additional information, statistics, and frequently asked questions.

Besides the national level, the National Spinal Cord Injury Association has regional affiliate

chapters as well as local resources. Lastly, NSCIA devised a discussion forum for people with

spinal cord injuries. At the NSCIA community forum, people are able to discuss a broad range

of topics with others encountering similar experiences, to name a few: mobility equipment,

rehabilitation, sexuality and spinal cord injury, financial planning and new injuries. The

discussions are endless, and members can even create new forums. The National Spinal Cord



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Injury Association is a remarkable organization which provides over a million individuals who

are affected by spinal cord injuries, their families and friends, medical, scientific, community

service and business professionals, the media, students, government, elected officials, and the

public with comprehensive information and resources to meet their needs.




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                                      Teaching Strategies

       To maximize the potential of a student who suffers from a spinal cord injury, teaching

strategies allow for successful participation in planned activities, ending in a positive learning

experience for all individuals.

       One appropriate teaching strategy for individuals with spinal cord injuries is modifying

the environment. Some changes to the environment applicable to individuals with spinal cord

injuries include reducing the dimensions of the playing field by means of decreasing boundaries.

Another adaptation of the environment is perhaps changing the surface of the playing area.

Because the majority of students with spinal cord injuries are dependent on wheelchairs as means

of locomotion, these modifications help to equalize the playing field, thus allowing an individual

a greater chance for success.

       Equipment adaptations are another appropriate teaching strategy when educating students

with spinal cord injuries. Equipment modifications include changes in size, length, weight, and

texture, as well as using specialized equipment. Introduction of lighter equipment for individuals

with spinal cord injuries may be extremely beneficial for the reason being that these individuals

may be deficient in strength of the lower extremities especially, the area responsible for the

majority of a person’s force. Specialized equipment includes any additional equipment used to

guarantee success, for example bumpers in bowling. Equipment adaptations decrease an

individual’s chance of injury, as well as increase their chance for success.

       A third teaching strategy suitable for instructing students with spinal cord injuries

incorporates peers as tutors. Because the physical educator’s attention is focused on the class in

its entirety, peer tutors provide continuous feedback on a one-on-one basis which many benefit

individuals with disabilities. Additionally, this teaching strategy increases socialization which is



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imperative for all individuals, especially those individuals who are not a part of any social

networks.

       Modifying basic rules of activities is fitting when teaching students with spinal cord

injuries. Because these students may not be as physically fit as others within the class, these

individuals may become fatigued more easily. To accommodate these individuals, the length of

playing time may be shortened, or a game may be completed when reaching a lesser amount of

points. Another example of modifying basic rules for less mobile players, may be allowing two

or three bounces to get to the ball when playing tennis.

       Lastly, a teaching strategy that is appropriate when teaching all individuals, regardless of

a person’s capabilities is positive feedback. However, in reference to those students with spinal

cord injuries, because physical limitations may be grounds for difficulty in performing certain

activities, encouraging words or phrases may motivate individuals towards striving for success

within the physical education setting. This is crucial because a physical educator’s objective is

to promote life-long physical activity. If a student is turned away from partaking in any form of

physical activity during their school years, this may result in complications as an adult.

                                            References

Texas Woman’s University. (1997). Examples of basic strategies to accommodate learners with

       disabilities in regular physical education. Retrieved December 1, 2006, from

       http://www.twu.edu/INSPIRE/strategi.htm




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                                           Activities

       The following activity descriptions and accommodations are established for a student

with a T6 spinal cord lesion. This individual possesses trunk stability, however, is dependent on

a wheelchair as primary means of locomotion.

       The activity chosen for an elementary physical education class is bowling. Although the

individual possesses trunk stability, the student may have difficultly in being successful when

bowling because of range of motion limitations. Because bowling is an individual sport

performed in a more relaxed atmosphere, defining player roles may be less critical.

       The length of the bowling lane will remain the same for this individual; however, the

individual may utilize a specialized piece of equipment, a bowling ramp. This student is

permitted to reposition the bowling ramp to a desired position for optimal success in knocking

down all ten pins. Because this individual is using a bowling ramp, a heavier ball may ensure

success.

       Paired with other classmates, a predetermined rotation is necessary for maintaining a

smooth class period. Assuming the student with a spinal cord injury began as the bowler, at the

completion of his or her frame, he or she would wheel themselves towards the end of the lane.

Here the individual would wait for the second bowler to complete his or her turn. The individual

with a disability would then gather the knocked over pins and realign them in a pyramid. The

classmates would continue this rotation throughout the class period.

                           http://www.twu.edu/INSPIRE/strategi.htm



       The activity intended for a middle school physical education class is volleyball. Various

modifications are appropriate in order to maximize participation and success. With regards to



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space, additional players may participate; therefore there is less area for each individual to

defend. The individual with the disability will be placed closer to the net, allowing for ease in

returning the ball.

       Additionally, modifications in basic rules include allowing the individual to catch the ball

before returning the ball back into play or allowing the ball to bounce. An equipment adaptation

includes using a lighter, softer, beach ball to reduce the speed of the ball. Lastly, bright colored

balls can be used for increased motivation and excitement.

                       http://www.pecentral.org/store/volleyballexcerpt.pdf



       The activity designed for a high school physical education class is dance. Dance is a

magnificent activity for the non-ambulatory student as well as the ambulatory students. It is

essential for the physical education teacher to partner the student with a spinal cord injury with a

trustworthy and caring peer for safety precautions, as well as they themselves maintain a

watchful eye throughout the class period.

       When performing a partner dance, the ambulatory student must place one hand on the

wheelchair, with their other hand on the person to direct the wheelchair while maneuvering

throughout a dance step. Twirl steps can be performed during wheelchair dancing with the

ambulatory peer twirling underneath the raised arm of the individual with a spinal cord injury.

Lastly, the physical education teacher must stress the importance that under no circumstances

should a peer be pulling or tugging on the student with a spinal cord injury.

                        http://www.asd.k12.ak.us/depts/APE/adaptations/




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