Sports Medicine: Just the Facts

PREPARTICIPATION EXAMINATION

• Goals of the preparticipation examination:
  •To identify medical and orthopedic conditions that
  may affect safe or effective athletic participation.
  •To review the chronic medical status of the Special
  Olympics athlete and identify need for special assis-
  tance or restrictions.


• SOI requirements:
  
  
  • Preparticipation questionnaire: The athlete or the
    athlete’s guardian, parent, or caseworker completes
    a standardized, comprehensive health history every
    3 years. The health data documented in the prepar-
    ticipation questionnaire is listed in Table 99-2.
  
  
  • Preparticipation examination (PPE): A physical
    examination of each athlete is required on entry into
    the program and a minimum of every 3 years there-
    after. A new examination is required whenever an
    athlete develops a new medical problem.
  
  
  
  

1. Examination guidelines: No specific examination
   requirements have been mandated except for the
   evaluation of Down syndrome athletes for
   atlantoaxial instability, if they will be participat-
   ing in an activity that may involve hyperextension
   or flexion of the neck or upper spine. The general
   approach to the PPE should be similar to that
   applied to athletes without disabilities, as demon-
   strated in the Preparticipation Physical
   Evaluation Monograph, 2nd edition.


2. Abnormal examination
   a. Sport-significant abnormalities are identified
   in up to 40% of PPE on Special Olympic ath-
   letes.

b.Guidelines from the Preparticipation Physical

Evaluation Monograph, 2nd edition, select

American Academy of Pediatrics (AAP) posi-

tion statements and the 26th Bethesda

Conference, along with subspecialty consulta-

tion, should be utilized to guide the individual

assessment of qualification for participation

when a medical condition is identified, which

may increase the risk of injury or may be

adversely affected by sport.

• Special Olympic athlete profile
  
  
  • Gender breakdown: Male = 60%, female = 40%
    •Average age of athletes: 22 years
    •Average number of sports competed in: 1.6 events
  
  
  • Prevalence of the most commonly identified health
    conditions:
  
  
  
  

1. No health problems indicated: 50%


2. Chronic medication use: 25–30%


3. Vision impairment: 15–27%


4. Emotional, psychiatric, or behavior problems:
   18%


5. Hearing impairment: 8–10%


6. Seizure disorder: 8–12 %
   •Down syndrome athlete
   
   
   • Definition: Down syndrome is the most common
     human malformation pattern and results from tri-
     somy of chromosome 21. Its incidence is currently
     estimated at 1 in 600–800 live births. Medical prob-
     lems are frequent and have a significant impact on
     sports participation. Orthopedic problems occur
     because the chromosomal abnormality results in a
     defect in production of normal collagen. The abnor-
     mal collage produced results in generalized liga-
     mentous laxity and decreased muscle tone. Up to
     30% of Special Olympics athletes have Down syn-
     drome.
   
   
   • Relative risk of injury: 3.2 times greater than other
     Special Olympics athletes.
   
   
   • Atlantoaxial instability
     
     
     1. Definition: Atlantoaxial instability (AAI) denotes
        laxity of the transverse ligament of C1 (atlas)
        which stabilizes the articulation of the odontoid
        process of C2 (axis) with C1. As a result of
        increased mobility, C1 may spontaneously sublux
        on C2 with resultant compression of the cervical
        spinal cord.
     
     
     2. Incidence: Approximately 15% of children with
        Down syndrome have radiologic evidence of
        AAI, which may also occur in patients with
        rheumatoid arthritis and bone dysplasias.
        3.Cause for concern: AAI can lead to frank
        atlantoaxial dislocation, a life-threatening condi-
        tion, manifest as abnormal gait, neck pain, lim-
        ited neck mobility, head tilt, incoordination,
     
     
     
     
   
   
   
   

582 SECTION 7 • SPECIAL POPULATIONS

TABLE 99-2 Health Data from the Preparticipation
Questionnaire

Heart disease/heart defect/hypertension Chest pain or fainting spells
Seizures or epilepsy Concussion or serious head
injury
Diabetes Heat stroke/exhaustion
Down syndrome and history of cervical Exercise induced wheezing
spine imaging
Sickle cell disease/trait or any bleeding Impaired motor ability and/or
diathesis use of wheelchair
Serious bone or joint disorders Hearing impairment and/or
use of hearing aid
Emotional, psychiatric, or behavioral Vision impairment and/or
problems use of corrective lenses
Absence of vision/blind in one eye Dentures or false teeth
Absence of one kidney or testicle Allergies (medications, food,
or insects)
Major surgery or illness Immunization status,
including date of last
tetanus
Parent or sibling with premature Current medications and
cardiac disease dosages