Physcial Disabilities

Refers to more than 140 conditions that affect the joints, most commonly the knee hip and spine, with pain and stiffness being the common symptoms. Arthritis can affect people of all ages including children but generally affects people as they age.

Considerations: Managing pain by not overusing or stressing the affected areas is important.

A Traumatic Brain Injury (TBI) is caused by an external force. A brain injury caused by internal factors, such as stroke, would be considered an Acquired Brain Injury (ABI).

Each brain injury is unique – there is no reliable way to predict how an individual’s brain will be affected by a particular injury. Moderate to severe brain injury may result in:

• Fatigue.
• Physical Disability – affecting Mobility, Pain, Speech, Senses.
• Cognitive Disability – affecting attention, memory, processing, language, intellectual flexibility.
• Emotional and Behavioural Disability – including anxiety and depression, excess or absence of behaviours, agitation, impulsiveness, aggression, lack of drive.
• Hemiplegia or Hemipareses is common with brain injury and refers to a paralysing or weakening that affects one side (hemisphere) of a person.

Considerations: Always wear a helmet! If unknown, check ability on the learner slope as student may have a historical perception of their ability. Check for epilepsy and, if not controlled, use a harness on the chairlift. Take your time to learn how the TBI affects the person so you can adapt communication equipment and expectations accordingly. Be empathetic to inappropriate behaviour but set appropriate boundaries, use repetition if necessary due to memory loss.

Someone who is receiving treatment or in remission can be affected with fatigue, pain or nausea and other longer term affects dependent on the type of cancer and treatment plan. Some treatments increase susceptibility to sunburn.

CP is a group of disorders that affect the ability of the brain to control muscle movement. Depending on which part of the brain is affected CP may affect muscle tone, co-ordination, control, reflex, balance, and posture. Individuals with cerebral palsy may or may not have an associated epilepsy, cognitive impairment, and/or sensory impairment.

There are different terms you’ll come across relating to CP that may refer to the area of the body affected, muscle tone, or motor function. Watch below for these different types…

Considerations: Do not force or stress limbs to be in a certain position, loosely support or strap limbs If necessary to avoid Injury, monitor effect of fatigue, temperature, and anxiety on a person’s movement.

A condition that occurs when the pancreas does not make enough insulin to keep blood glucose (sugar) levels in the normal range, or when the insulin it produces is not effective. Insulin allows glucose in the blood to be transferred into the cells to be used for energy.

Low blood sugar can cause shakiness, confusion, fatigue, hunger and may result in sweating or a headache. If it drops too low it may result in unconsciousness or seizure.

Considerations: Treat low blood sugar quickly by giving sugar in the form of high sugar drinks, milk, orange juice or hard sweets, followed by a small snack.

Affects the Central Nervous System which controls movement and response to the senses of touch, vision, and hearing. Although the cause is not known for certain, the effects are a result of an inflammation affecting the myelin sheath (which encases nerves), and the nerve cells. In addition to nerve damage, inflammation may leave multiple areas of scar tissue (sclerosis) on the coverings of the nerve cells resulting in residual effects.

Symptoms can vary from person to person and episode to episode. The impact can be mild to severe, the disease can progress slowly over a period of months or years or may worsen in a stepwise fashion with each relapse. It is possible for the disease to go into complete remission, or for symptoms to ease for periods of time.

Symptoms may include: Loss of control of bladder and bowel function; Fatigue; Pain; Spasticity – ranging from muscle tightness to muscle spasm; speech and swallowing issues; Thinking and memory issues; Vision loss including blurring; Loss of contrast; Double vision or eye pain.

Considerations: Where possible teach in a colder part of the day or season, avoid over-stressing the student both mentally and physically, check for any associated sensory impairment particularly vision. Be aware that performance may vary from day to day and over time.

A group of disorders involving deterioration/loss of muscle cells and tissue resulting in progressive muscle weakness. Students may begin skiing or riding standing up without support, and over a number of season progress to using outriggers, and then to using a bi-ski.

Considerations: Avoid fatiguing the student and take frequent breaks. Take care when lifting and avoid falls due to possibility of loose joints due to loss of muscle tone, change position frequently to reduce stiffness associated with being in the same position for long periods.

A condition where the two sides of the embryo’s lower spine do not join together leaving an open area. If the nerves are damaged as a result, control of the muscles (typically leg , bowel and bladder) and sensation in these areas may be affected. Some people with spina bifida have a build up of fluid in the brain known as hydrocephalus – requiring a shunt to drain the fluid.

Considerations: As for spinal cord injury and after big falls check for headaches or double vision due to hydrocephalus and if there seek medical attention, may have a latex allergy (latex is sometimes used in sticking plaster and medical gloves), if Harrington Rods are present reduce likelihood of high impact landings.

An injury to an area of the spinal cord which results in an impairment or loss of function and or feeling. The damage can be complete, resulting in a complete loss of movement and sensation or incomplete resulting in partial loss of movement and /or sensation. Someone with an incomplete spinal cord injury can often walk and stand up ski or snowboard.

SCIs are classified into either:

1. Paraplegia (legs), or
2. Quad/Tetraplegia (majority of the body including arms and legs)

The spinal column is comprised of 26 individual bones called vertebrae which are divided into four different areas. Nerves exit at each of these vertebrae so damage at the vertebrae affects the nerves at or below this point.

• Neck – cervical vertebrae C1-C7
• Chest – thoracic vertebrae T1-T12
• Lower back – lumbar vertebrae L1-L5
• Bottom of spine (sacrum) – sacral vertebrae S1-S5

Considerations: check seat straps, boots, clothing for anything that may cause a pressure sore, be aware of cold in legs/feet where there may be a loss of sensation, check that any straps are not putting pressure on a catheter or colostomy bag, above T6 be aware of ADS.

Autonomic Dysreflexia (ADS) or hyperreflexia can occur where there is an injury at level T6 or higher. It is caused by an irritation, such as pressure, temperature, or full bladder occurring below the injury level. When there is no response to the nerve impulses caused by the irritation (due to the injury) an abrupt onset of dangerously high blood pressure occurs. This is considered to be a medical emergency.

Signs: Pounding headache, goose bumps, sweating above the Injury and cold and clammy skin below the injury, blotching of the skin

Actions: relieve any potential pressure points, catheter blockage, or any other potential irritant stimulus and seek urgent medical attention. Individuals at risk of ADS are made aware of the symptoms and what to do during rehabilitation and so may be aware of the onset.