Dr Derek Martin

Medical Officer For the GB Paralympic Swimming Team

Recent Past

Athens 2004

16 Gold

20 Silver

16 Bronze

Total 52

Durban World Championships 2006

24 Gold

14 Silver

16 Bronze

Total 52

World Champions

Amputees

Stump injuries/infection

Prosthesis shorter for the swing through

-hip, pelvic and back pain.

Injuries to artificial limbs!

Falls

Visually Impaired

ClassificationTotalUp to 2/60 /or a field of less than 5 degrees.2/60 – 6/60 or field loss of 5-20 degrees

Falls/cuts/collisionsMissed tappingPoolside checks

Cerebral Palsy

Complex conditionSpastic – motor cortexChoreo-athetoid – Basal Ganglia or CerebellumMono-QuadriplegiaEpilepsyIntellectual impairmentVisual defectsSpeech impairment

Spinal Lesions/Injuries

Sensory/motor lossUrinary retentionFractures due to osteopeniaBowel impactionPressure soresIncrease in shoulder injuries.Hand, median/ulnar nerve injuriesAccessPunctures

High Spinal Injuries

Thermoregulation

Autonomic dysreflexia

Boosting

Impaired cardiac response above T2-4

Loss of intercostal muscle function

Thermoregulation

Loss of autonomic functionLoss of sensory afferent impulses below level of lesion may limit hypothalamic response. Loss of sweating/vasodilatation.Loss of shiveringStrategies needed for extreme conditions

Autonomic Dysreflexia

Medical emergency

Lesions above the splancnic sympathetic outflow (C2-T6)

Irritant stimuli below this level

Causes

Bladder distension

Irritation of the urinary tract

Skin ulcers

Fractures

Abdominal emergencies

Uterine contractions

Mechanism

Impulses ascend the spinal chord to the sympathetic cell bodies resulting in massive sympathetic discharge.

Symptoms

Intense headache

Profuse sweating

Nasal stuffiness

Signs

Goosebumps

Facial erythema

Pallor distal to lesion

Blood pressure > 200 mm Hg

Sequelae

Seizures

Pulmonary oedema

Increased force and rate of cardiac contractions

Dysrythmia

Cerebral haemorrhage

Death

Treatment

Treat the underlying cause

Sit patient up

Sublingual nifedipine

Boosting

Increased output 7-10%

Banned in 1994

Call up room checks if BP > 180 mm Hg systolic athlete withdrawn

Previous records can be requested

Policing difficult

Multiple Disability

Athens opening ceremony

Paraplegia

Epilepsy

Laryngomalacia

Ulcerative colitis

Ileostomy

Thank You!