prosthesis , which might require a longer paddle length to compensate for the lack of opportunity to get low for sweep strokes and support strokes .
AMPUTATION A person following amputation will often use a prosthesis . Clever systems are being developed for the upper limb amputee , but you are more likely to see below-knee amputees coming for paddling lessons . They usually wear a prosthesis that requires a suspension via a strap , suction socket or internal pin . They will be required to wear a specialist sock to help comfort and fit of their prosthetic limb , all of which can be problematic in their own way when we introduce water-based activities .
There are specialist swimming limbs ; however , these often have less mobility or are less comfortable . It ’ s best to work out with the amputee or their ’ prosthetist for more specialist advice . The lower the level of amputation , the more balance and ability they often will have . A below-knee amputee can often utilise a prosthetic foot with some ankle movement , whilst a higher level might need a more rigid foot or knee . Initially , the amputee will need to increase their weight into a normal midline alignment so that they put even weight through the board . Often their uninjured limb is dominant , so confidence exercises and balance retraining may be necessary to improve symmetry and help them on their board .
The amputated limb can often still be very sensitive , and the nerve endings will need to make new sense of the new activity . This may require desensitisation of the residual limb due to pressure changes , and care should be taken not to cause trauma to the skin due to other redistribution of pressures . Any new discomforts should be discussed with their prosthetist and the limb adjusted to enable optimal weight-bearing . It may take several weeks and attempts to help the amputee feel comfortable with the added weight-bearing pressures , and it should be built up slowly over time .
Different board types will have a different effect on the prosthetic foot and alignment of the leg for normal paddling biomechanics . An ISUP may allow more flex options softening the leg for paddling , but it can cause added balance issues whilst a hardboard can give the paddler greater reference and trust , but this can cause increased pressure . Initially , some paddling should be done sitting to allow some crossing of the midline and increasing the way the body transfers weight during the paddle stroke over the affected side before this is attempted in standing .
Moving around the board is more challenging , so more emphasis is needed on learning support strokes and utilising the paddle like an outrigger for added stability and support . This is again compromised due to a lack of foot bend and knee bend in the
NEUROLOGICAL IMPAIRMENTS There are so many different types of neurological impairments , and it will be impossible to go through them all here with you today , but I will try to give you some basic similarities . Most people will have problems with the resting tone of the muscles , either creating too much tension or not enough . This will change posture and movement . Some people will not be able to sit unsupported , let alone stand . It is kinder to start with cross-training in an outrigger canoe first to enable greater stability for the paddler . Some people won ’ t be able to stand but will have some ability to control their trunks . We can add a special seating system for these people to support prolonged sitting or use a wider board for greater stability .
The skin is at risk of injury due to altered sensation and circulatory changes due to muscles not firing correctly . They often cannot get the correct information from the environment , for example , the temperature , where they might not be aware of the cold , or pressure they might not feel if their skin is being rubbed . This means extra vigilance is needed to protect the individual during the sport as abrasions can stop a wheelchair user from being active . If they develop a sore they will need to sustain long periods of bed rest , therefore , it is recommended we protect the skin with protective clothing such as a wet suit or other thicker material . Specialist matting or cushions on the board can also be utilised for pressure relief as we should be conscious to not have them on a hard surface in one posture for too long . This might also make you opt for an iSUP over a hardboard , where pressure on the skin is more significant .
Be aware they can get involuntary contractions in their muscles from tone issues ; these are called spasms . This may result in an involuntary jerk or reflex response when you least expect it . So please be vigilant as it can create a capsize or make it difficult for the paddler to maintain their balance or posture , and if they are strapped into a seating system , this can be very nerving for the paddler who is putting all their trust in you . I find it best to be in the water with them rather than on my board myself , and I usually choose a very sheltered environment which is torso depth , for the first few sessions . Also , make sure there are enough team members available from a manual handling point of view for the level of disability .
If the person is less neurologically impaired , they may be able to control their sitting balance themselves . This will make things a lot easier , but they can still
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