Individuals with a Pre-Existing Disability

Dr. Osman Ahmed, PhD, PGDip (Sports Physiotherapy), has reviewed this page for accuracy.

This resource includes up-to-date research on how pre-existing disabilities impact the diagnosis, treatment, and recovery from concussions. The information is relevant for individuals with a pre-existing disability, however, many sections have a focus on para-sport athletes and the blind or visually impaired community. We acknowledge that this page only begins to cover the topic, but we hope this resource is impactful for individuals with a pre-existing disability navigating a concussion.

This article is an excerpt from our resource Concussions and Individuals with a Pre-Existing Disability on the Concussion Alliance website.

Contents:

Overview and Introduction

Identifying and Treating Concussion in Individuals with Disability

Athletes with Pre-Existing Disability: An Overview

Concussion Education for Athletes with Pre-Existing Disability

Concussion Testing for Athletes with Pre-Existing Disability?

Return to Sport Guidelines for Athletes with Pre-Existing Disability

Interview with Paralympic Skier Millie Knight

Persisting Symptoms for Individuals with Pre-Existing Disability?

Mental Health and Pre-Existing Disability?

Disability Stigma and Navigating Healthcare

Blind/Visually Impaired Individuals?

Related Blog Posts

Acknowledgments

Overview and Introduction

Concussions are common but often deceptively complex injuries that pose unique challenges for individuals with a disability. According to the United States Census Bureau, close to 1 in 5 Americans live with a disability, and more than one billion people worldwide live with a disability. Epidemiologists estimate that, each year, 55.9 million concussions occur worldwide. Individuals with a pre-existing disability who sustain a concussion may struggle with inadequate testing and diagnosis, unusual symptoms, unique mental health challenges, and disability stigma in healthcare.

The Americans with Disabilities Act (ADA) defines disability as “physical or mental impairment that substantially limits one or more major life activities. The term includes chronic and terminal illnesses; communication and neurological conditions; and developmental,hearing, intellectual, learning, psychiatric, physical, sensory, and vision disabilities. Disability can be visible or invisible, temporary or permanent, life-long or acquired.”

Identifying and Treating Concussion

These areas may be potential barriers and require specific considerations for concussion patients with a pre-existing disability.

1. Accurate testing and diagnosis: Certain concussion assessments need to be modified based on the individual's disability. Vestibular tests may need to be modified for paraplegic and blind/visually impaired individuals because oculomotor tests are not applicable. Blind/visually impaired individuals may need additional testing, including memory and cognitive tests, to compensate for providers’ reliance on visual assessment in concussion.
2. Recovery time: Recovery time may be prolonged for individuals with certain disabilities. Further research is still necessary to understand the long term effects and recovery trajectory for para-sport athletes, adaptive sport athletes, and all individuals with a disability.?
3. Navigating health care: Individuals with disabilities can struggle with discrimination in favor of able-bodied individuals (ableism) when trying to navigate health care. Because concussion symptoms may overlap with pre-existing symptoms, receiving a diagnosis can be more challenging. Check out our section below on tips for navigating healthcare with a pre-existing disability.

Disabilities with an increased likelihood for sustaining a concussion:

Individuals with the following disabilities may have an increased fall risk, or reduced ability to be aware of their surroundings. This poses the risk of running into other objects or people.

• Individuals who are blind or visually impaired
• Disabilities with increased fall risk such as those with developmental disabilities, gait dysfunction, muscle weakness etc.
• Neurological disorders such as epilepsy
• Intellectual disabilities

Athletes with Pre-Existing Disability: An Overview

Below we’ve outlined a list of organized sports federations that are present for individuals with disabilities:

Paralympic Movement: Physical disability, blind/low vision, intellectual disability

Special Olympics: Intellectual & developmental disability

Deaflympics: Deaf or hard of hearing

Adaptive Sports: Any disability

Popular para-sports

• Sled Hockey
• Para-Alpine Skiing
• Blind Football
• Para-Cycling
• Wheelchair Basketball
• Wheelchair Rugby

Para-athletes are individuals with impairments who play sports that have either been adapted for their impairment group or created specifically for it. Most of the current research on concussion in sport has been done on able-bodied athletes; however, new studies are beginning to understand the increased risk faced by para-sport athletes, and by extension, all athletes with disabilities. A concussion, also called a mild traumatic brain injury, is caused by a blow, bump, or jolt to the head, neck, or body that transmits an impulsive force to stretch, compress, and twist the brain, which alters normal brain functioning. Learn more about what happens to your brain when you sustain a concussion on our page here.

Concussion Education for Athletes with Pre-Existing Disability

Concussion education is a crucial component for the prevention, diagnosis, treatment, and understanding of concussion for individuals with a pre-existing disability. Concussions are serious injuries that have the potential to lead to persisting symptoms. Educating athletes, clinicians, and sports staff about proper guidelines for assessment and treatment that is specific to athletes with a pre-existing disability is essential. Athletes should not be told to “shake it off” or feel pressured to return to the game. Coaches and sports physicians should always err on the side of caution if a concussion is suspected in an athlete. In addition, creating sports rules, providing protective equipment, and adapting sports equipment can increase safety for athletes.?

Continue reading this article here: Concussions and Individuals with a Pre-Existing Disability on the Concussion Alliance website.