1. Medical Officer For the GB Paralympic Swimming Team
Dr Derek Martin
Medical Officer For the GB Paralympic Swimming Team

2. Recent Past
Athens 2004
16 Gold
20 Silver
16 Bronze
Total 52

3. Durban World Championships 2006
24 Gold
14 Silver
16 Bronze
Total 52

4. World Champions

5. Amputees Stump injuries/infection
Prosthesis shorter for the swing through
-hip, pelvic and back pain.
Injuries to artificial limbs!
Falls

8. Visually Impaired Classification Total
Up to 2/60 /or a field of less than 5 degrees.
2/60 – 6/60 or field loss of 5-20 degrees
Falls/cuts/collisions
Missed tapping
Poolside checks

13. Cerebral Palsy Complex condition Spastic – motor cortex
Choreo-athetoid – Basal Ganglia or Cerebellum
Mono-Quadriplegia
Epilepsy
Intellectual impairment
Visual defects
Speech impairment

14. Spinal Lesions/Injuries
Sensory/motor loss
Urinary retention
Fractures due to osteopenia
Bowel impaction
Pressure sores
Increase in shoulder injuries.
Hand, median/ulnar nerve injuries
Access
Punctures

15. High Spinal Injuries Thermoregulation Autonomic dysreflexia Boosting
Impaired cardiac response above T2-4
Loss of intercostal muscle function

16. Thermoregulation Loss of autonomic function
Loss of sensory afferent impulses below level of lesion may limit hypothalamic response.
Loss of sweating/vasodilatation.
Loss of shivering
Strategies needed for extreme conditions

17. Autonomic Dysreflexia
Medical emergency
Lesions above the splancnic sympathetic outflow (C2-T6)
Irritant stimuli below this level

18. Causes Bladder distension Irritation of the urinary tract Skin ulcers
Fractures
Abdominal emergencies
Uterine contractions

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

20. Symptoms
Intense headache
Profuse sweating
Nasal stuffiness

21. Signs Goosebumps Facial erythema Pallor distal to lesion
Blood pressure > 200 mm Hg

22. Sequelae Seizures Pulmonary oedema
Increased force and rate of cardiac contractions
Dysrythmia
Cerebral haemorrhage
Death

23. Treatment Treat the underlying cause Sit patient up
Sublingual nifedipine

24. 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 180 mm Hg systolic athlete withdrawn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

25. Multiple Disability Athens opening ceremony Paraplegia Epilepsy
Laryngomalacia
Ulcerative colitis
Ileostomy

27. Thank You!