Phillip Conatser

Chris Ledingham

About 2.5 million people have seizure disorders in the United States, and those individuals with disabilities have a higher prevalence of seizures than people without disabilities. For example, a disability such as cerebral palsy in which the percentage of seizure occurrence could range from 25% - 35% of the population, and for people with intellectual disability as high as 1/3. Individuals with disabilities may also present other challenges such as their lack of ability to recognize/remember early warning signs of an oncoming seizure, e.g. “Aura” (dizziness, nausea, muscle pain, or bitterness in the mouth). Those with disabilities also may have problems communicating to educators how often they are having seizures, how they are feeling daily, the need for medication adjustments, and possible triggers.

Whatever the situation, all people that have seizures should take extra precautions before participating in a physical activity program. Physical educators, personal trainers, coaches, aquatic instructors, and anyone who works with people who have seizures should have a basic understanding of the disorder, know what to do during a seizure, know when to call 911, and have an understanding of the strategies one can utilize to make the environment safe.

Although the American Red Cross and the Heart Association discusses seizures in first aid classes, it is very brief. We hope to expand this knowledge as well as share other helpful ideas and strategies. The article is presented in a question and answer format. Enjoy and be safe!

Q - What is a Seizure?

A - A recurring central nervous system problem, whereby there is an upset in the electrical activity of neurons within the cerebral cortex of the brain. When a person has a seizure the cells in the brain are unable to maintain normal balance and depolarization (change in electrical activity) occurs too easily and frequently. One must also realize that seizures can affect only one part of the brain or the whole brain. In general, seizures are not life threatening; however, close monitoring is highly recommended.

Q - What are the different types of seizures?

A - There are three general types of seizure and each is briefly described below.

Generalized tonic-clonic seizure (grand mal) – This type typically involves the entire brain/body, usually lasts about 2 to 4 minutes, and results in a temporary loss of consciousness. The first phase is referred to as the tonic phase (stiffening of the limbs) followed by the second phase, the clonic phase (jerking of muscle). People can have tonic clonic seizures (both), tonic or clonic only (one), and/or a tonic clonic tonic seizure (combinations). This type of seizure affects muscle control, causing people to collapse, fall to the ground, and produce moaning noises. Sometime during the tonic phase breathing is shallow, gaspé, or erratic. Safety considerations for loss of muscle control must be implemented and monitor breathing.

Complex partial seizure (Jacksonian) - This type involves only part of the brain/body, usually lasts 1 to 5 minutes, and may result in some loss of consciousness (memory, awareness). This is the most common type of seizure. A person's arms may curl up, they may rub their hands rapidly, they may exhibit incoherent talking, and/or a temporary loss of muscle strength which causes the head to drop or legs to collapse. Again, protection is of the upmost importance when seizures affect large muscle control and conscious decisions are not under their own volition.

Absence seizure (petit mal) – This type of seizure involves only part of the brain/body, usually lasts about 10 to 30 seconds, and the person may experience some loss of awareness and appear dazed or confused. Other possibly signs of Absence seizures include eye twitching, staring or gazing away, and not being able to talk. Absence seizures usually do not effect large muscle groups and therefore, do no typically fall or drop to the ground. Some people may experience 100's of these mild seizures every day.

Additional characteristics of seizures may include babbling, lashing-out, bladder loss, and after the seizure, temporarily sleep. All types of seizures effect, at some level, the ability to make appropriate decisions and some form of muscle control, therefore safety and proper supervision is very important.

What to do during a seizure?

To some degree these steps should be taken in order and without delay.

First, make sure the person is in a safe place. You may have to help them off equipment to the floor or simply guide them away from hazards such as the current playing area, stairs/steps, the street, or drop-offs on the playing field.

Second, if the person is lying on the ground, place them on their side to allow secretions to drain. In some situations, educators may need to move the child from a hot blacktop or sidewalk to a grassy area. If the seizure occurs in the swimming pool, get them out and place the victim on their side so water will not enter their lungs. In the event CPR is require for a person that has had a seizure in the water, lay them on the side first and do abdominal thrusts. Additionally, make sure no water is in their mouth before doing CPR.

Third, check ABC’s (Airway, Breathing, Circulation)

Fourth, protect their head, loosen tight clothing, and clear the area of sharp or hard objects.

Fifth, time the seizure.

Sixth, don’t put anything in mouth or give them fluids.

Seventh, stay with the person until the seizure ends, let them rest until fully conscious, and be reassuring and supportive.

Q - When should I call 911?

A - The American Red Cross and the American Heart Association have a list of criteria that should be followed. This list includes the first responder being aware of the following:

- First known seizure.
- Seizure lasting more than 6 minutes. *
- Multiple seizures without regaining consciousness. *
- Heat related seizures.
- If the person is diabetic.
- Seizure related to head trauma or injury.
- Suspected seizure that is related to drug overdose.
- Suspected cardiac or stroke condition related seizure

* For some people seizures lasting more than 6 minutes and/or having multiple seizures without regaining consciousness is normal and not an emergency, however, this information will need to be obtained from the persons’ physician. If there is any doubt, call immediately for medical help (school nurse, EMT).

Q - What are some of the factors that aggravate seizures?

A - While some people with seizure disorders will be able to recognize and avoid common triggers, there is no real way of knowing when a seizure will occur or what will necessarily trigger one. The following are common factors which may aggravate seizures.

- Rapid change in body temperature
- Over heating
- Dehydration
- Poor nutrition
- Hypoglycemia/hyperglycemia
- Sleep deprivation
- Depression and emotional stress
- Hyperventilation
- Not taking medication as prescribed
- Drug overdose
- Strobe lights
- Menstrual cycle

Note that usually it is a combination of several factors that increase seizure activity such as not sleeping well, eating irregular, stressed about school, and over exertion during an aerobic class may trigger a seizure.

Q - What are some of the common treatments for seizure disorders and their possible side effects?

A - There are several medications which are used to treat/prevent seizure disorders. Three of the common medications are Dilantin, Tegretol, and Luminal. However, like many medications those used to treat seizure disorders have some side effects. These side effects may include coordination difficulties, being lethargic, dizziness, nausea, fatigue, tremors and increase or decrease in appetite. Knowledge of these side effects can help educators plan activities accordingly, make daily adjustment as needed, and help the educator to be more understanding toward the student.

While it is usually the primary caregiver’s or school nurse’s role to ensure that the student is taking their medication appropriately, the educator may be one of the first to notice subtle changes in the student. If this occurs the educator should convey this to the child’s primary caregiver’s. People with disabilities may have memory deficits and limited communications skills, therefore the school personal must communicate internally, to the parents, and parents to the doctor what seizure behaviors are being observed so medication(s) can be effective and appropriate safety measure can be implemented. If there is a breakdown in communication between parties involved, this could be disastrous for the student.

Another treatment regimen is the use of a Ketogenic diet. This option is sometimes used when traditional medications are not controlling seizures. This is a high fat diet, which working off your own metabolic system, releases ketones which naturally relax the body. One potential problem with this form of therapy is excessive weight gain. Typically, most people who use this method are only on the diet temporarily, until a more permanent solution can be found.

Q - What are some of the common strategies for physical activity that I should be aware of with regards to students with seizure disorders?

A - With proper safe guards, students who have seizures should participate in all activities. Not participating in activities may result in the student doubting his own abilities and lowering his or her self-esteem. An “Over Protected Child” may have life-long negative effects on their health and fitness.

As an educator it is important to know which students have seizure disorders. The educator, based on district policy, may want to have students fill out a brief medical history or ask the school nurse. After identifying which students have seizure disorders, communicate regularly with them, the school nurse, the classroom teacher, and/or the parent about their condition. It is your responsibility to stay informed. Do not assume someone else will tell you about students that have seizures or changes in seizure behavior. Communication between the doctor, parent(s), schools nurse, classroom teacher, and physical educator is imperative for the safety of the student who has seizures.

Both prior to and/or after a student has a seizure the educator should review the potential risks and dangers of activities. Educators may also need to repeat instructions missed prior to, during, and after the seizure. Additionally, both educators and paraprofessionals should learn how to recognize seizures for immediate and prompt action.

Educators can also help students that have seizure disorders identify internal changes that occur before the onset of a seizure and provide appropriate actions to minimize possibly injury. Teaching a student to “yell” or “call” for help is a simple, safe means of identification of an upcoming seizure.

In the event that a child has seizure the educator should emphasize to other students that seizures are not contagious, teach friendship skills, and that everyone can help in taking care of each other. Sometimes a friend is the first person to identify and help when a seizure occurs.

Seizures usually occur during the cool down after exercises or activities. To help mitigate the onset of a seizure the educator may want the student to do the following:

- Have a longer warm-up.
- When exercising, take frequent breaks,
- Avoid over exertion and extreme heat,
- Have the student drink more water to ensure proper hydration.

Q - What special precautions could be taken during activities?

A - Each activity will need to be evaluated separately as each activity will pose its own risks. Below are a few examples of proper precautions.

Have the student wear appropriate head protection for contact sports or activities that risk head injuries.

During swimming activities (a) use the “buddy” system, (b) use a smaller group setting, (c) use one-on-one instructor to student ratio, and (d) use personal flotation device (PFD). Use of a PFD, small group setting, and constant supervision can make swimming activities fun and safe. However, if the students is experiencing more frequent and violent seizures and is currently not feeling well instructors should choose alterative activities that are not in the pool. Even at home, during bathing careful supervision is needed, because of the danger of drowning.

During gymnastics activities or climbing a rope use experienced spotters and extra mats.

If the student will be doing some form of rock climbing activity the educator needs to ensure the person properly uses a safety rope to prevent falling. Free rock climbing is not recommenced.

Exercises, games, and sport activities should be on soft surfaces such as grass, mats, or sand vs. hard wood floors, tile, or concrete.

When hiking, go with a buddy or use a guide rope.

When riding a ski lift use a safety strap.

If downhill skiing, use the buddy system or use a guide rope.

When bike riding use a bicycle-built-for-two or choose trails with less hazards.

If scuba diving or snorkeling always have an experienced partner.

If needed, have a change of clothes.

It is worth repeating; if seizures are out of control, changes in medication, and/or the person is not feeling well, choose alternative activities that are lower risk.

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