Four-Track Skiing, A Clinic Outline
December 2003MEDICAL INFORMATION
DISABILITIES
The following are some examples of disabilities that may require a person to four-track. You will be responsible for more information.
Spina Bifida (Open spine) - Congenital birth defect where part of the spinal cord forms outside of the spine. The site of the lesion determines what damage occurs. May have a shunt from the head.
Spinal Cord Injury - Injury to the spinal cord, causing partial or complete loss of sensation and function below the level of injury. Amputation - partial or total loss of limb(s). Can be congenital, from trauma, or from disease.
Brain Injury - An injury to the brain, including strokes and cancer, where damage occurs. Resulting symptoms are determined by which section of the brain is affected. Effects can be physical, cognitive, social and/or emotional.
Post-Polio - Impaired muscle control due to poliomyelitis.
Progressive Diseases - Disabilities whose symptoms progress during the course of a person's life.
Multiple Sclerosis (MS) - A progressive disease of the central nervous system in which the myelin sheath, the coating around the nerve fibers in the brain and spinal cord, is damaged.
Muscular Dystrophy (MD) - A progressive disease in which the muscles deteriorate.
Always check to see what medication(s), if any, student is taking. If you do not recognize a medication, find out specifically what it is and what the side effects are before skiing with that student. Medications are grouped by what they treat (classes). Some medications have dual purposes.
MEDICATIONS: USE OF MEDICATIONS AND POSSIBLE SIDE EFFECTS| Type | Examples | Uses |
| Analgesic | Percoet, Naprosyn | relieves pain and discomfort |
| Anti-Cholinergic | Daricon, Ditropan | controls bladder spasms |
| Anti-Coagulant | Coumadin, Heparin | blood clot prevention |
| Anti-Convulsant | Dilantin, Phenobarbitol, Clonopin | controls seizures |
| Anti-Emetic | Phenergan, Vistaril | controls nausea and vomiting |
| Anti-Inflammatory | Decadron, Motrin, Advil, Naprosyn, Indocin | swelling, joint pain, arthritis, gout |
| Anti-Spasmodic | Dantrium, Valium | relieves muscle spasms |
| Sedative (also known as a tranquilizer) | Valium, Thorazine | reduces agitation, anxiety |
DISABILITY RELATED CONCERNS
The instructor must assess and anticipate any complications related to a specific disability and the environment, especially medication variations due to environment, physiological or psychological changes.
EVALUATION AND EQUIPMEMT SETUPA medical history should contain a written evaluation of a student's abilities. Using this as a guideline, an on-site, practical assessment is completed prior to skiing. Appropriate equipment can then be chosen.
Practical AssessmentStudent evaluation allows the instructor to get an idea of general and current function. Things to look for in the assessment include:
- Disability - Assess what the disability is and when it began. This will allow you to determine if additional precautions are needed. Check for other hidden disabilities.
- Stance/Balance - Start with the overall picture and work into fine detail. Assess the use of walking aids and how they will be incorporated into skiing. Note the position of the legs/feet/hips when in a balanced stance. How will this be maintained while skiing?
- Gait - Watch the hips/legs/feet swing through and land on the ground. Watch joint movement.
- Strength - Use simple tests to evaluate strength, in the legs, arms, and torso.
EQUIPMENT
Use the above evaluations to choose the appropriate equipment. Equipment needs will vary with each individual. Possible needs are:
- Braces, Orthotics - Personal braces and orthotics are put directly in the boot to maintain stability.
- Leg prosthetics - There is a difference between a ski leg and a walking leg. Use cants, lifts, and wedges to give the proper lean to the walking leg. Make sure the leg(s) is on tightly with a prosthetic sleeve and/or thigh lacer.
- Cants, Wedges - To be used in the boot to have the boot, thus ski, flat on the snow.
- Slant Boards - Used to make the ski flat when the person is in normal walking position.
- Outriggers - Help with lateral stability.
- Ski bra - Help with lateral stability and muscle control.
- Bungee cord and pipe - Helps with lateral stability and muscle control. The pipe can be of a size to maintain a wedge (spreader bar) or parallel skis.
- Reins - Helps with speed control. Aids student in changing direction.
- Walker - Mounted on skis providing more lateral stability and possibly standing assistance.
- Clothing - Make sure it is adequate.
- Padding - Needed to protect braces and body.
TEACHING AND COMMUNICATION TACTICS
Written and practical assessment can help determine teaching technique. Remember, just because some aspect of the body does not function, does not mean the brain does not function. Use appropriate teaching styles for the student's learning style. Mechanically, start with what the ski is doing and how an able-bodied person accomplishes that movement, and then adapt the students' body movements to allow them to get their skis to perform. Stay as close to able-bodied movements as physically and psychologically possible to minimize extraneous motion. Often a more direct, hands-on approach is needed to accomplish this. Some examples of assists are:
- Tip hold
- 2-point hold
- Reins - Know what they are and how to use them
- Inverted wedge
- Lift procedures with braces, walkers and other equipment
- Four-track demonstrations
- Assists to a standing position
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