ACTIVITY AND SEIZURES
Conatser & Christopher
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
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
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.
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
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.
check ABC’s (Airway, Breathing,
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.
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
- Heat related seizures.
- If the person is diabetic.
- Seizure related to head trauma or
- Suspected seizure that is related
to drug overdose.
- Suspected cardiac or stroke condition
* 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
- Poor nutrition
- Sleep deprivation
- Depression and emotional stress
- 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
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
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
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.
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
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
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