tami pasquel ctrs, cbis, cdss - wordpress.com › 2014 › 12 › ski... · o it is the predominant...
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Tami Pasquel CTRS, CBIS, CDSS
Adaptive Sports Specialist
James A Haley VA, Tampa, FL
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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:
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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
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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
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Decreased Processing
Auditory
Visual
Visual Impairments
Field Cuts, Blind Spots
Hearing Impairments
Concrete Thinking
OCD symptoms
Decreased Awareness
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Neurofatigue
Know the signs Increased distraction, decreased attention
Increased falls
Decreased communication
Changes in decision making, problem solving
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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
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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
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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
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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
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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
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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
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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:
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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:
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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.
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Questions?
Tami Pasquel CTRS, CBIS, CDSS Adaptive Sports Specialist
James A Haley VA, Tampa, FL [email protected]