Military Sports Medicine Fellowship The Challenged Athlete "Each Warrior an Athlete" Kevin deWeber, MD, FAAFP Director, Primary Care Sports Medicine Fellowship Acknowledgments to Dr. Mark WilliamsSlide 2
Objectives Review orders of inabilities Describe PPE necessities Discuss the study of disease transmission of harm and sickness Describe remarkable medicinal issues Prepare for restorative scope of Special Olympics occasionsSlide 3
Types of incapacities (difficulties) Physical difficulties Intellectual handicaps Subaverage scholarly working and stamped debilitation in versatile conduct Sometimes both exist togetherSlide 4
Physical Disability Classification Wheelchair competitors Cerebral paralysis "Les autres" ("the others") Limb insufficiencies Hearing weakness Vision impedanceSlide 5
U.S. Paralympics Governing body for donning rivalry in those with physical inabilities "U.S. Paralympics, a division of the U.S. Olympic Committee, is devoted to turning into the world pioneer in the Paralympic sports development, and advancing greatness in the lives of people with physical disabilities." U.S. Paralympics siteSlide 6
Archery Basketball Boccia Curling Cycling Equestrian Fencing Goalball Judo Powerlifting Rowing Rugby Sailing Shooting Skiing (elevated and Nordic) Sled Hockey Soccer Swimming Table Tennis Track & Field Volleyball Paralympic SportsSlide 7
Mental Retardation In the United States: 100,000 conceived every year with mental impediment 7 times more predominant than visual impairment 7 times more common than deafness 10 times more pervasive than physical handicap 12 times more predominant than cerebral paralysis 35 times more pervasive than solid dystrophySlide 8
"Extraordinary Olympics is a global philanthropic association devoted to enabling people with scholarly incapacities to end up physically fit, gainful and regarded individuals from society through games preparing and rivalry. Extraordinary Olympics offers kids and grown-ups with scholarly incapacities year-round preparing and rivalry in 30 Olympic-sort summer and winter sports." Special Olympics siteSlide 9
Mission To give sports preparing and rivalry to people with mental impediment age 8 through adulthood Children ages 5-8 may take an interest in preparing, however not contendSlide 10
Special Olympics exercises Sports preparing and rivalry for kids and grown-ups exist in every condition of the U.S. Facilities, camps, Games held at neighborhood, provincial, state, national, and universal levelsSlide 11
Special Olympics Games First International Special Olympics - 1968 2005 Special Olympics World Winter Games 1,800 competitors, 84 nations 2003 World Summer Games 6,500 competitors, 150 nations Over 2.2 million competitors around the worldSlide 12
Goals Physical wellness Social advancement Acceptance into bigger societySlide 13
Eligibility Identified by an organization or expert as having mental hindrance OR Have a psychological deferral as controlled by institutionalized measures OR Have critical learning or professional issues because of intellectual postponement which require uncommonly composed directionSlide 14
Levels of Participation Divisioning: Gender Age 8-11, 12-15, 16-21, 22-29, 30+ Ability Athletes scored taking into account capacity in particular aptitudes Goal: 3-8 members/groups of comparable capacity in every occasionSlide 15
Alpine skiing Cross nation skiing Figure skating Floor hockey Speed skating Badminton Golf Powerlifting Table tennis Team handball Official Sports Winter and DemonstrationSlide 16
Aquatics (swimming and jumping) Track and field Basketball Bowling Cycling Equestrian Gymnastics Roller skating Softball Tennis Volleyball Soccer Official Sports SummerSlide 17
Preparticipation Physical Evaluation Requirements History and physical exam required on section Update each 1-3 years, contingent upon state Requirements not institutionalized Special Olympic Games: PPE < 12 months New exam required when another issue builds up that could represent a danger for the competitor amid games supportSlide 18
Preparticipation Evaluation PPE must be custom fitted to address their exceptional needs Office-based exam favored Frequency of irregular discoveries Diagnoses frequently connected with bunches of strange discoveries Enhanced interpersonal correspondenceSlide 19
Level of freedom Wheelchair Motor weakness Prosthetic hardware H/O autonomic dysreflexia Testicle (nonattendance?) Kidney (nonappearance ?) Urinary catheters? Correspondence issues Additional History NeededSlide 20
PPE: Special Concerns Communication Many Special Olympics competitors have expressive and responsive dialect lacks 5% of competitors are non-verbal May be not able portray manifestations plainly Utility of PPE Questionnaire at occasions: Available to therapeutic supplier for audit Must be kept upgraded and conveyed to all rivalriesSlide 21
Exam Abnormalities in Non-Disabled Athletes versus Special Olympians Nondisabled competitors: 0.3 – 3% have precluding variations from the norm Special Olympians-39% have irregularities Not inexorably all excluding.Slide 22
Sports Significant Disabilities McCormick, Ivey, et al 1988 80 competitors in Special Olympics sports PPE 39% had sports noteworthy variations from the norm Vision more awful than 20/40 13% Seizures 13% Cardiac arrhythmia Cyanotic coronary illnessSlide 23
Sports Significant Disabilities Hudson (Physician & Sportsmedicine 1988) 176 Preparticipation Physical Exams Age = 5-20 years Visual sharpness of 20/30 or worse 40% Decreased LE Flexibility 31% Clonus 12% Spasticity 8% Heart murmur 5% Scoliosis 3%Slide 24
Seizure 23 Down Syndrome 16 Cerebral Palsy 15 Hydrocephaly 4 Meningomyelocele 4 Multifocal leukoencephalopathy 1 Progressive Sz d/o 1 Sickle Cell dz 1 Muscular Dystrophy 1 Renal oddities 1 Sports Significant Disabilities Hudson (Physician & Sportsmedicine 1988) Medical Diagnoses ever (#)Slide 25
Down Syndrome 417 Epilepsy 239 Cardiac sore 88 Cerebral paralysis 33 Asthma 24 Hypothroidism 22 Hemiparesis 11 Severe vision dist 11 Diabetes 10 Hydrocephalus 9 Ataxia 7 Microcephaly 6 Paraplegia 5 Phenylketonuria 3 Conditions Encountered on Pregame Medical Exam of 1512 Competitors at U.K. Extraordinary Olympics,1989 Robson, Br. J. Sports Med. 24:225,1990Slide 26
Height and Weight Blood weight Visual Acuity Eye,ear, nose, throat Cardiorespiratory auscultation Abdominal, including hernia and testicular check Screening orthopedic, including scoliosis Focused orthopedic Screening neurologic Physical ExamSlide 27
Visual Exam About 1/3 will have variation from the norm Poor visual keenness most regular Others: Refractive mistakes Astigmatism strabismusSlide 28
Physical Exam Routine general exam Focus on regions that frequently uncover issues Musculoskeletal Cardiovascular Neurological Derm (wheelchair, prosthetics) Functional AssessmentSlide 29
Musculoskeletal Examination Wheelchair competitor: thoughtfulness regarding shoulder, wrist and hand Amputees: consideration regarding back and bring down furthest points Downs: thoughtfulness regarding c-spine exam Hip and knee exam, precariousness basic Cerebral paralysis: contractures, quality, muscle awkward nature; thoughtfulness regarding hips, knees, lower legs and feet which have high rates of abuse wounds.Slide 30
Down Syndrome Major Musculoskeletal Disorders Metatarsus Primus Varus Problem with shoe fit Hallux Valgus Patellar Instability Scoliosis Slipped Capital Femoral Epiphysis Most because of deformity in collagen combination, bringing about summed up ligamentous laxitySlide 31
Down Syndrome Cervical Spine Abnormalities Atlantoaxial Instability Occiput-C1 Instability Odontoid Dysplasia (6% of Down patients) Hypoplasia of back curve of C1 Spondylolysis and Spondylolisthesis of midcervical vertebrae Precocious Arthritis of C4-C6Slide 32
Atlantoaxial Instability (AAI) Up to 15% of Down disorder have a laxity of the transverse tendon of C-1 (chart book) which balances out the verbalization of the odontoid procedure of C-2 (pivot) with C-1 If too much remiss, C-1 may suddenly sublux forward on C-2 bringing about pressure of the cervical spinal ropeSlide 33
Atlantoaxial Instability 10%-20% of Down disorder people have asymptomatic AAI 1-2% have symptomatic AAISlide 34
Atlantoaxial Instability: Diagnosis Lateral x-beam of the cervical spine in flexion, unbiased, and augmentation Look at Atlas-Dens Interval (ADI) Distance between foremost ramus of C-1 and the nooks of C-2 Should not surpass 4.0mm All Down disorder competitors must get a demonstrative x-beam of the c-spine before entering Special Olympics cooperationSlide 36
Normal ADI in impartial position. Expanded ADI in flexion.Slide 37
Normal: take note of no expansion in ADI with flexion.Slide 38
AAI: note increment in ADI with flexionSlide 39
Cardiovascular Exam Cardiac mumbles are basic Grade2/6 or gentler and systolic = no further assessment Diastolic mumble or systolic 3/6 or louder = further assessment Blood weightSlide 40
Down Syndrome Cardiac Lesions Endocardial Cushion Defect Ventricular Septal Defect Less Commonly Secundum Atrial Septal Defect Tetralogy of Fallot Patent Ductus Arteriosus 36 th Bethesda Conference models applySlide 41
Ventricular Septal Defect History of inability to flourish and dyspnea on effort Murmur = holosystolic and loudest in the third and fourth left interspaces Work-up and any vital mediation preceding cooperation Fairly normal in Down Syndrome May bring about issues amid Sports occasionsSlide 42
Endocardial Cushion Defect Embryologic antecedents of the atrioventricular trench, mitral and tricuspid valves Defects of va
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