Tami Pasquel CTRS, CBIS, CDSS

Adaptive Sports Specialist

James A Haley VA, Tampa, FL

o It is the predominant injury being sustained

secondary to blasts & explosions

o The injury is unique to the individual much like one’s own signature

o It is usually compounded with the possibility of sustaining multiple physical injuries (Polytrauma).

o May not have been diagnosed

Traumatic brain injury (TBI) is being named the

“signature injury” for these reasons:

Short Term Memory Poor Carry Over

Problem Solving

Decision Making If having difficulty making decisions give them 1-2

choices

Organizational skills May need assistance with setting up equipment,

planning their day on the slopes

Decreased Social Skills Impaired understanding of relationships

Bond quickly due to environment

Disinhibited

Easily Distracted http://www.youtube.com/watch?v=SSUXXzN26zg

Easily Overstimulated Move to a quiet area for instruction

May need to remove from environment

Take a Break

Perseveration They may repeat the same thing. Redirect or take a break

Decreased Processing

Auditory

Visual

Visual Impairments

Field Cuts, Blind Spots

Hearing Impairments

Concrete Thinking

OCD symptoms

Decreased Awareness

Neurofatigue

Know the signs Increased distraction, decreased attention

Increased falls

Decreased communication

Changes in decision making, problem solving

Can alter “normal” cognitive skills

May or may not resolve as they acclimate to

altitude

Medication reaction may be altered

Medications may not be absorbed properly due to

altitude

They may self medicate to adjust to changes –

May be contraindicated unless cleared by

physician

TBI / Polytrauma presents interesting problems

for instructing such individuals in adaptive sports

participation.

Problems identified are:

o Type of Instruction

o Communication

o Equipment Selection

Verbal – Give Step by Step instructions 1-3

May need to break these steps down – Think of a

recipe

If there is more than 1 instructor – Make one the

lead and the other support.

Repetition is key but don’t over do it

Visual – Show the participant how to do a skill

Role Playing – Participant follows your lead

Perform the skill then the participant performs

Hand in Hand technique – have participant

perform the skill with you

Talk to them like an adult.

Speak slowly if they need extra time to

respond

Slow processing skills – slow reaction or response

Don’t get technical or use “Slang”

Nonverbal

Participants may say one thing but the body’s

actions says something else.

Know when to talk to the therapists

This can set the tone for the day

This can be very overwhelming and disrupt their personal space

Choose your environment well

Communication is vital

Make your intentions known before you proceed

Let them know changes can be made

Be aware of your location

If you are not making eye contact you need to evaluate your position and communicate

Trust is not always earned in any situation

Perception What you say or do may be different from what they

hear and see

Disinhibition May make inappropriate comments

Decreased Social Skills

Protect Yourself Keep normalcy but be aware

o Determines type of instruction

o Communication

o Equipment Setup

o Body Language / Body Position

o Anticipating Reactions

o Expect anything or Expect Nothing

PTSD can effect instruction in adaptive sports

participation by:

o Outbursts

o Anxiety

o Aggression

o Emotional Detachment

o Poor Concentration

o Poor Short Term Memory

o Flashbacks / Night Terrors

o Hypervigilent

o Substance Abuse

Post Traumatic Stress Disorder (PTSD) occurs in those who have

been exposed to traumatic experiences, often during their

military service. Effects a part of the brain involved with

learning and memory.

Behaviors may include:

o Eliminate confusion by keeping it simple

o Involve family member/caregiver and therapist

o Talk directly to the participant and only refer to

caregiver for understanding

o Ask for feedback following each training session

o Treat them as an adult

o Be friendly and sociable but be aware

o Don’t forget – they were at one time (perhaps recently)

able-bodied and physically & mentally strong.

Questions?

Tami Pasquel CTRS, CBIS, CDSS Adaptive Sports Specialist

James A Haley VA, Tampa, FL Tamara.pasquel@va.gov