Patient Reported Outcomes in Clinical Practice

Posted January 17, 2017

Beth Druvenga
M.S. Ed, LAT, ATC

By Beth Druvenga, M.S. Ed, LAT, ATC

As athletic training pushes to the forefront of healthcare professions, it is necessary for us to also change with the times. The Institute of Medicine urges healthcare educational programs to incorporate outcomes that are reported by the patient into their curriculum as to enhance clinicians’ decision making processes and drive forward patient centered care.1 Patient reported outcomes (PROs) are a valuable tool for Athletic Trainers (ATs) to add to their arsenal of evaluating their patient as a whole. With the addition of PROs into educational programs,1 this gives the student a chance to learn how and when to utilize these outcomes. It also makes it easier to analyze and interpret the results.

Many clinicians are hesitant to use PROs, especially in the fast-paced world of athletic training. Some of the greatest barriers to using PROs are time, comprehension and independence. Most clinicians and patients, report that it takes too much time to complete the surveys, and therefore, do not want to include them in their plan of care. Others report that patients don’t understand the questions and cannot properly fill out the survey without dependence on the clinician.1 How can we break through these barriers?

Initially, it may take time to walk the patient through the survey, but after they understand it, they can independently complete it at subsequent times. On the patient’s side, they can complete the survey while they are hooked up to electrical stimulation, icing or heating. This breaks down the time, comprehension and dependency barriers. It could be easily argued that recording PROs is as important to the patient’s rehab as recording objective measures of range of motion, strength and flexibility.

Once you’ve decided to use PROs, there are some things to consider for picking the correct outcome measure to use. First is to select the type of PRO. There are PROs to record the overall health related quality of life, the patient’s whole body health or information that focuses directly to one area of the body. The PRO that focused directly to one area of the body will be best suited for the outcomes most ATs will want to measure.

Once the type is determined, it’s time to decide on the quality of the PRO. In determining the quality, a clinician should look at the reliability and validity of the measure. This is to make sure that the outcome measure accurately shows change over time for the intended population and evaluates items which are important to the clinician and the patient. 2 Other elements to look at are the stability of the measure to reproduce a same score when a patient’s health status has not changed and responsiveness to detect how true the change in the score is over time.2

Along with the internal elements of the outcome measure, the measure also should be patient and clinician friendly, easy to use and score and support the goals that have been made for the patient. If you are interested in adding PROs into your practice but are still not sure where to go, http://www.orthopaedicscores.com/ is a valuable website. This resource has PROs grouped into specific categories as well as offers printable excel files.

One of the best reasons to use patient reported outcomes is to increase communication with the patient and to direct the patient’s care plan.1 Utilizing PROs in conjunction with clinician reported outcomes can enhance the rehabilitation process. Imagine the scenario of a patient returning from ACL surgery. By utilizing PROs, they will be able to see their progress from day 1 to present. As ATs, we watch our patients go through the highs and the lows of their rehabilitation process, including days where they feel like they haven’t made any progress. PROs, in conjunction with clinician reported outcomes, are valuable tools to utilize in helping patients reach their goals.

Resources

1. Snyder Valier, A. R., Jennings, A. L., Parsons, J. T., & Vela, L. I. (2014). Benefits of and Barriers to Using Patient-Rated Outcome Measures in Athletic Training. Journal of Athletic Training, 674-683.

2. Valier, A. R., & Lam, K. C. (2015). Beyond the Basics of Clinical Outcomes Assessment: Selecting Appropriate Patient-Reported Outcomes Instruments for Patient Care. Athletic Training Education Journal, 91-100.

About the Author

Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.

 


Prevent Cold Weather Illnesses This Winter

Posted January 11, 2017

By Mackenzie Simmons AT, MSEd, ATC

Throughout winter, it is important to be aware of the signs and symptoms of cold weather illnesses, as well as the risk factors and preventative methods. While heat illness usually seems to be on the forefront of environmental issues, cold weather illnesses can cause the same catastrophic results. Athletic Trainers (ATs) and other healthcare professionals need to be knowledgeable in differentiating and diagnosing hypothermia, frostbite, chilblains and trench foot in athletes. A short summary of these cold weather illnesses are listed below.

Hypothermia (mild, moderate or severe) is caused by prolonged exposure to cold, wet or windy conditions, usually during endurance events or outdoor games.

Mild

- Core temperature 98.6F to 95F

- Cold extremities

- Shivering

- Pallor

Moderate

- Core temperature 94F to 90F

- Slowed respiration and pulse

- Cessation of shivering

- Dilated pupils

- Impaired mental function and motor control

Severe

- Core temperature below 90F

- Rigidity

- Severely depressed respirations

- Bradycardia

- Usually has fallen into a coma

Frostbite (mild or superficial) occurs when there is an exposure to cold temperatures, often in conjunction with wind or touching cold surfaces

Mild

- Area is firm or cold to the touch

- Limited movement

- White or blue-gray colored patches in skin

- Tingling or burning sensation

Superficial

- Area is hard or cold

- Burning, aching, throbbing or shooting pain

- White, gray, black or purple skin

- Tissue necrosis

Chilblain (or pernio) is caused when the body has prolonged exposure to cold, wet conditions.

- Red or cyanotic lesions

- Tissue necrosis

- Skin sloughing

- Swelling

Trench foot comes from prolonged exposure to cold, wet conditions; it usually occurs with the continued wearing of wet socks, wet shoes or both.

- Burning, tingling or itching

- Loss of sensation

- Cyanotic or blotchy skin

- Blisters or skin fissures

Sometimes, cold weather illnesses cannot be prevented in athletes, but there are risk factors that can predispose an athlete to getting hypothermia, frostbite, chilblain or trench foot. Listed below are a few of the risk factors for cold weather illnesses:

- Lean body composition

- Lower fitness level

- Females

- Older age

- Issues such as cardiac disease, Raynaud’s phenomenon and anorexia

- Previous cold injuries

- Low caloric intake

- Dehydration

- Fatigue

While most risk factors are genetic, there are a few that can be controlled. An AT can encourage athletes to stay properly hydrated and nourished before activity to ensure the body has enough nutrients to efficiently function. Also, make sure the athletes are at the necessary fitness level to perform the event in the cold weather. It is important to encourage the athletes to get a full night of rest leading up to the event so the body is not fatigued.

In addition to controlling the risk factors, the AT can also provide guidance on the proper clothing to wear to the event. When possible, the athlete should keep their hands, feet, toes and ears covered. Also, dressing in layers is essential to keeping warm—the first layer of clothes should allow sweat evaporation, the middle layer for insulation and then the outer layer being water and wind resistant. The AT should also monitor the wind chill before and during the event to make sure the weather is safe for activity.

Resources

Cappaert, Thomas A., et al. "National Athletic Trainers' Association position statement: environmental cold injuries." Journal of athletic training 43.6 (2008): 640-658.

 

 

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Utilization of Sport Psychology in the Rehabilitation Process

Posted January 9, 2017

Beth Druvenga
M.S. Ed, LAT, ATC

By Beth Druvenga, M.S. Ed, LAT, ATC

“Sports are 10% physical, 90% mental,” this common phrase used in sports is easily transferred into the world of injury rehabilitation. Sport psychology has started to be incorporated into the sports medicine realm.  Athletic Trainers (ATs) are required to participate in some type of psychological or behavioral classes as part of an athletic training program curriculum. Many people have heard of collegiate or professional athletes using psychological techniques such as imagery, stress reduction and positive self-talk as part of their pre-game regimen. They have credited these techniques as helping their game excel, but what if we transferred these techniques into the athletic training facility?

There are some athletes who still feel the stigma of psychosocial help and may not see it as the ATs “place” to employ sport psychology theories into the rehabilitation program.1 However, these interventions have been shown to have positive effects on athlete compliance to rehabilitation programs, better rates of recovery and may help alleviate stress or anxiety.4,3

As ATs, we are put into the unique role, which allows us to control many aspects of the rehabilitation process such as; creating a positive atmosphere, maintaining athlete compliance and providing social support for the injured athlete. We can easily facilitate the discussion with the athlete about how they feel regarding their injury, refer them to another healthcare professional or help them cope with their injury. ATs are on the front lines of student-athlete wellness. Having awareness and knowledge about the psychosocial aspects of the sport allows ATs to take greater care of the athlete, which will hopefully reduce injury recovery time.

Use your tools of the trade! As a professional, it is intrinsic to give our athletes feedback and cues on how to do their exercises correctly. We help set achievable goals in their rehabilitation and lift them up when they’re having a rough day in rehab. All athletes have some part of their identity associated with being an athlete. Being aware of any changes in this identity can be useful for an AT to help in identifying any issue that may appear. These are all subtle psychological interventions!1 Though subtle is sometimes best, there are some more direct ways that can be beneficial to the athlete.

Start by having the athlete write down goals for each week in a journal or on a rehab sheet. The ability to see these goals daily during rehab will ingrain in the athlete’s mind about what they have set out to do for the week and will motivate them to make progress.2 They can acknowledge their goals while doing specific exercises and visibly see their progress written out. Talking with the athlete about their motivation for recovery can also be helpful. By understanding the athletes “why” early in the recovery process, you can help remind them of this “why” during the difficult days.

Add imagery into their program. Imagery is a process which involves three steps: vividness, controllability and self-perception.5 Especially with post-surgical cases and prior to the exercise, have the athlete imagine the muscles they use to do a specific exercise (vividness). After they have done this for a few minutes, have them move on to imagining going through the exercise and completing it successfully and pain free (controllability). Then, after doing this step for a few minutes, finally have the athlete think about a time where they were performing at their best, what emotions they had and what it took for them to feel that way.5 Imagery can be used in pain management as well. Having the athlete view the pain as a “hot” color like red and change it to a “cool” color like blue, which can help reduce pain.6

Teach them positive self-talk. Athletes are quick to get down on themselves if they aren’t performing the task perfectly. Have the athlete use “I can”, or “I will” statements before tackling a tough exercise. This practice will positively engage the brain and give the athlete the boost to achieve their goal. Another way to enhance confidence is to view the setback or injury as a challenge and obstacle to overcome rather than a threat to athletic identity. Changing the perception will help the athlete remain optimistic during a potentially difficult period of life.

Create a peer to peer group.2 A peer to peer group can be led by a sport psychologist or qualified mental skills coach, which can meet to discuss the “boo’s and yay’s” of that day’s session. Athletes need to know they’re not the only one struggling with certain things. When they can dialogue with others in a controlled setting, they may find it beneficial to talk with others going through similar situations. They can also share techniques which have helped them and may  help other athletes.

Many ATs do not feel adequately equipped to walk athletes through the psychological aspects of return from injury. If this is the case, search for local sports psychologist or qualified mental skills coach, who work with adolescents or young adults. A great resource is the Association for Applied Sport Psychology, they have information for consultants in your area, as well are plenty of resources on injury/rehabilitation.

In the college/university setting, seek out your psychology or kinesiology professors. They may have an interest in the area of sport psychology and would be willing to provide guidance and expertise. Seek out workshops, lectures and continuing education that touch upon applying psychology into the athletic training facility. As ATs, we are uniquely taught and equipped to handle many different and difficult facets of injury, rehabilitation and return to play. We have an overflowing toolbox, but adding sport psychology training may prove to be a welcome addition.

**Huge thank you to my brother Joel Druvenga, a Master Resilience Trainer-Performance Expert with Comprehensive Soldier and Family Fitness at Fort Riley Army Base. He has a Bachelor of Arts in Psychology, Master of Education in Counseling with an emphasis in Sport Psychology.  He is also working toward a Doctor of Education in Kinesiology. He provided me with valuable insight into the realm of sport psychology and utilizing it in the sports medicine world, and added some great edits to this blog post.**

References

1. Arvinen-Barrow, M., Massey, W. V., & Hemmings, B. (2014). Role of Sport Medicine Professionals in Addressing Psychosocial Aspects of Sport-Injury Rehabilitation: Professional Athletes' Views. Journal of Athletic Training, 764-772.

2. Granito, V. J., Hogan, J. B., & Varnum, L. K. (1995). The Performance Enhancement Group Program: Integrating Sport Psychology and Rehabilitation. Journal of Athletic Training, 328-331.

3. Hamson-Utley, J. J., Martin, S., & Walters, J. (2008). Athletic Trainers' and Physical Therapists' Perceptions of the Effectiveness of Psychological Skills Within Sport Injury Rehabilitation Programs. Journal of Athletic Training, 258-264.

4. Heaney, C. A. (2006). Recommendations for Successfully Integrating Sport Psychology Into Athletic Therapy. Sport Psychology & Counseling, 60-62.

5. Richardson, P. A., & Latuda, L. M. (1995). Therapeutic Imagery and Athletic Injuries. Journal of Athletic Training , 10-12.

6. Taylor, J., & Taylor, S. (1997). Psychological approaches to sports injury rehabilitation. Gaithersburg: Aspen Publishers.

About the Author

Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.

 

 

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Nutrition, Recovery and Injury Prevention for Basketball Players

Posted January 3, 2017

Desi Rotenberg
MS, LAT, ATC

By Desi Rotenberg, MS, LAT, ATC

Basketball is a sport that requires several complex movement patterns, both within the individual and the team. Before an exercise specialist can create a training and nutrition program for any sport, it is important to first fully understand the game as a whole. This includes, but is not limited to, the specific movement patterns required to optimize performance as well as how to decrease overall time to fatigue in-game and during off-court training. Coupling movement patterns with a deliberate hydration plan and nutrition plan can optimize performance, while ensuring the athlete’s body can handle the strenuous mental and physical demands of the sport itself.

Nutrition

Basketball requires a combination of movements that include strength, endurance, power, agility, quickness and proprioception. While a single game lasts between 32 and 48 minutes, depending on the level, the actual exercise time may only be a fraction of that time. A single player will undergo 1 high intensity run every 21 seconds and spends nearly 60 percent of their playing time undergoing low intensity activity .2

In order for each player to maximize their performance on the court, they must ensure they have properly fueled the energy systems needed. The training needs of the sport will also need to be taken into consideration: the average basketball player trains between 2-3 hours per day, 4-6 days per week.2 Additionally, it is estimated that the average basketball player runs between 1 and 3 miles per game. These values have only been confirmed at the professional level with state-of-the-art tracking technology. Currently, the record belongs to Jimmy Butler, who ran an average of 2.74 miles per game during the 2015-2016 NBA season.

Nonetheless, a basketball player’s diet must reflect that of the short-term, high intensity movements coupled with long-term low intensity energy demands. The table below illustrates the nutritional requirements for basketball players at the high school and post-secondary levels:

  Men Women
Calories

2,500-3,000 (High school)

3,000-3,500 (Post-Secondary)

2,200-2,700 (High School)

3,500-4,000 (Post-Secondary)

Protein

1.4-1.7 g/kg

1.4-1.7 g/kg

Carbohydrate

2.7-4.5 g/kg

2.7-4.5 g/kg

It is recommended athletes eat a high carbohydrate, low fat meal roughly 3-4 hours prior to the start of a practice or competition. A small snack should be consumed 1-2 hours prior to the start. This snack should be relatively high in carbohydrate (juice, cereal bar or bagel) and have some protein (peanut butter, milk, cheese or yogurt) in order to prepare the athlete’s body for the energy need required. The protein will help initiate the athlete’s muscle recovery following completion of the practice or competition. Less than 1 hour prior to the start of the practice or competition, the athlete should consume a sports drink. This will help prime the athlete’s short-term energy system and contribute to hydration, which will help prevent fatigue.

During the practice or competition, it is recommended the athlete drink water or colored sports drinks that are kept at a cool temperature. This will prevent dehydration and exercise-induced hypoglycemia. Basketball players should be taking breaks and consuming either water or a sports drink roughly every 15-20 minutes during play.1

Injury Prevention

According to a 2016 study by Bird and Markwick published in the International Journal of Sports Physical Therapy, injury prevention within the basketball population is a combination of the ability to recognize poor movement patterns and the theoretical likelihood to predict future injury incidents.3  A meta-analysis of basketball injury prevalence showed amongst high school basketball players, an injury will occur 2.08 times per every 1,000 exposures in boys  and 1.83 per times per 1,000 exposures in girls.3 An exposure being an opportunity for an injury to occur within practice or in-game. Concurrently at the collegiate level, the injury rate substantially rises: 9.9 times per 1,000 exposures in men and 7.68 times per 1,000 exposures in women.3

Furthermore, as expected, the lower extremity was the most common region of the body to have sustained injury amongst basketball players. Ankle sprains during landing accounted for nearly 45 percent of all lower extremity injuries. In females, knee injuries that occur during a cutting or rotational movement account for nearly 30 percent of all injuries amongst high school and collegiate basketball players.3

As mentioned above, given the knowledge we have about the specific injuries that occur within the sport, we can begin to predict future injury occurrences. Bird and Marwick explain it as “injury prevention through prediction; an approach that is used to assess fundamental movement qualities in order to identify and predict overall injury risk.”3

Recent research suggests that movement screens are moving away from the traditional isolated muscle strength assessment tests. They are moving towards an integrated approach that evaluates fundamental movements related to the assessment of “an athlete’s movement competency, or the fundamental mechanics required over a period of time within a specific sport.”3 In simple terms, the assessment should focus on the fundamentals, which can then be continuously trained to ensure a safe, yet effective improvement in overall sport performance.

Below are a few of the functional assessment tools utilized by this study and their practical applications. Each test is scored on a scale of 1-3 (1 being can not complete without major flaws; 2 being can complete but with some flaws and 3 can execute with technical proficiency).3

1. Hop and Jump Variation Assessment

a. A good way to assess neuromuscular control using single leg hopping, hopping for distance and timed hop.

b. Practical Application: These assessments will allow the practitioner to visualize any neuromuscular control deficits, muscular strength deficits or imbalances, knee position and trunk position/compensation.3

2. Landing Error Scoring System

a. Known as the “Drop Box Vertical Jump test;” evaluates 17 jump-landing characteristics

b. Practical Application: Considered a reliable screening tool in the identification and prediction of non-contact ACL injuries through the evaluation of landing mechanics.3

3. Tuck Jump Assessment

a. Allows for evaluation of the ability of the hip, knee and ankle to absorb force during take-off and landing, specifically targeting the stretch-shortening cycle.

b. Practical Application: The ability to identify and predict lower extremity dysfunction such as high risk landing patterns, knee loading patterns and neuromuscular control within the hip, ankle and knee in conjunction with the trunk.

4. Weight Bearing Lunge Test

a. Correct landing technique can be visualized through ankle dorsiflexion range of motion

b. Practical application: can be a predictor of ankle injuries caused by poor force absorption within the ankle due to a lack of ROM.3

5. Star Excursion Test

a. Used to assess static and dynamic balance and neuromuscular control that involves single leg balance in 8 different directions. This will allow for the assessment of “ankle dorsiflexion, knee flexion, overall knee and hip range of motion, and proprioception.”3 Considered a reliable and predictive measure of lower extremity injuries within high school basketball players.4

b. Practical application: The ability to identify and/or predict chronic ankle instability, ACL deficiencies and patellofemoral pain.

Sleep and Recovery

Furthermore, a 2011 study by Mah, et al. out of the Stanford Sleep Disorder Clinic, investigated the effects of sleep extension on specific measures of athletic performance as well as the effect of sleep on reaction time, mood and daytime sleepiness in collegiate basketball players. It was noted an athlete who receives 79.7 additional minutes of sleep (~1.2 hours) per night, can see substantial improvements in performance in strenuous physical requirements, cardiorespiratory functioning and psychomotor tasks that include memory, learning ability and reaction time.5

Sleep extension will be predominantly critical within the collegiate and professional athletic population. This is due to the frequent travel across several time zones and into several different locations within the United States in a relatively short period of time. It was noted in this same study that collegiate basketball players travel on average of 2-3 times per month, with trip duration lasting anywhere from 3-5 days.5  This study reinforces the notion that at any level and within any sport, athletes require additional sleep in order to ensure optimal performance.

Through the use of a predictive model, the practical application of nutritional requirements, injury prevention and sleep extension can ensure optimal performance within the sport of basketball at any age level. Often times these aspects of athletic competition go unnoticed and only come to the forefront following an injury, burnout, nutrient deficiencies or an incident that is secondary to 1 of these occurrences. While there are specialists geared towards nutrition, sleep and injury prevention at the professional and collegiate levels, it will be important for high school athletic coaches and staff to understand the correlation between proper nutrition, proper sleep, injury prevention and overall performance and success within the sport in general.

Resources

1. Academy of Nutrition and Dietetics, (2016). “Fueling Basketball Players.” https://www.nutritioncaremanual.org/vault/2440/web/files/SNCM/Client%20Education%202014/Basketball%20Players-4-2014.pdf. Accessed: December 5, 2016.

2. McInnes, S. E., Carlson, J. S., Jones, C. J., & McKenna, M. J. (1995). The physiological load imposed on basketball players during competition. Journal of sports sciences, 13(5), 387-397.

3. Bird, S. P., & Markwick, W. J. (2016). Musculoskeletal Screening and Functional Testing: Considerations for Basketball Athletes. International Journal of Sports Physical Therapy, 11(5), 784.

4. Plisky, P. J., Rauh, M. J., Kaminski, T. W., & Underwood, F. B. (2006). Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players. Journal of Orthopaedic & Sports Physical Therapy, 36(12), 911-919.

5. Mah, C. D., Mah, K. E., Kezirian, E. J., & Dement, W. C. (2011). The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep, 34(7), 943-950.

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 

 


Do You Really Know the ECC Requirement?

Posted December 22, 2016

Avoid common audit problems like completing the wrong course, letting your ECC certification lapse or tossing old documents too soon.

The Card Code is highlighted in yellow.

The BOC regularly conducts audits of ATs to verify compliance with certification requirements – a critical part of assuring public safety. Our audits sometimes reveal lapses in maintaining an Emergency Cardiac Care (ECC) credential due to mistaken beliefs about the requirement. Other times, ATs report ECC certification at a lower level than the minimum BOC requirement (see sidebar).

Following are common but unacceptable reasons given for a lapse in ECC certification:

- I’m not currently practicing as an AT

- I’m not working in the field

- I’m in school

- I didn’t know what level of CPR I need

- I didn’t keep all my cards, whether expired or current

The Certificate ID is highlighted in yellow.

In an effort to help with lost cards, we have added a field to the continuing education reporting form in your BOC Central™ profile. The new field, under the “Emergency Cardiac Care (ECC)” section, asks for the certificate ID or card code (see screenshot).

This information allows the BOC and other organizations to access American Red Cross and American Heart Association systems to verify ECC certification – which allows us to help you in the event of an audit. We encourage you to enter ECC information in your as soon as you receive a new card or certificate.

What Level Is Your ECC Certification?

 ECC certification must include all of the following:

- Adult CPR

- Pediatric CPR

- Second rescuer CPR

- AED

- Airway obstruction

- Barrier devices (e.g., pocket mask, bag valve mask)

Full details of this category are located in the Certification Maintenance Requirements starting on page 3.

Finally, remember that ECC documents must be kept for 2 years after expiration. The only acceptable documents are original certification cards, original certificates of completion, or photocopies (front and back) of certification cards or certificates of completion. The instructor and card holder must sign cards or certificates of completion if a QR code is not provided. Letters provided by instructors are not acceptable.

 

 

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In-Depth Look: Assistant Athletic Trainer for The Original Harlem Globetrotters

Posted December 19, 2016

Austin Burns, ATC is the Assistant Athletic Trainer for The Original Harlem Globetrotters. The Harlem Globetrotters are an exhibition basketball team that combines athletics, performing arts and comedy.

Describe your setting:

I work in a setting with a mixture of professional sports and performing arts.

How long have you worked in this setting?

I have worked in this setting for a little over a year and will be beginning my second tour this holiday season.

Describe your typical day:

Depending on the city we are playing in and how far we have to travel to the next city, my day will typically begin around 6:00am. We are usually on the bus by 8:00am and then off to the next location. After traveling for roughly 4 to5 hours, we check into our hotel and grab a quick lunch.

Afterwards, I head to the arena to meet up with our production and equipment truck. I’ll start by meeting with the arenas facility manager to locate the locker rooms and familiarize myself with the layout of the building. I’ll then help the truck driver unload all of my equipment and supplies; this is usually in a hallway somewhere.

The players, coaches and remaining staff arrive to the arena around 4:00pm and hold a walk through practice. At 5:00pm, I begin all of the pregame routines including stretching, taping, prehab exercise, and various other treatments depending on the needs of the athletes. At 6:45pm, the pregame entertainment begins so I’ll end all treatments and get changed for the show. The show starts at 7:00pm and runs for 2 hours.

During the show, my primary focus is no different than any other Athletic Trainer (AT). I manage acute injuries, perform wound care, make sure the athletes are hydrated and stay alert for anything out of the ordinary. Following the end of the show, the athletes have an autograph session for 20 minutes. I use this time to make ice bags, pack my equipment, load the truck and perform any additional treatments.

By 10:00pm, we are back on the bus and on our way to the hotel. Once in my room, I enter in the medical notes for the day and try to get to bed by 12:00am so I can repeat it all the next day.

What do you like about your position?

What I like most about my position is how creative and adaptive I have to be when working on location. Not having a designated room to perform treatments and exercise can be very challenging. Most days, I find myself performing corrective exercise and prehab on the bus, manual and soft tissue therapies in the hotel room and ice baths in the hotel room tubs. This can be difficult when working with athletes who are all over 6 feet 5 inches tall and can’t fit in the seats, beds or tubs.

What I also love about my position is getting to see the joy people experience when coming to one of our shows. So many children and adults leave the game smiling and laughing. To know you helped make that happen is really rewarding.

What do you dislike about your position?

The hardest part about the position is being on the road for 5 to6 months at a time. Being away from friends and family can start to take a toll on you. Fortunately, you begin to develop a small family with the athletes and staff involved in the production, which helps with the home sicknesses.

 What advice do you have about your practice setting for a young AT looking at this setting?

The advice I would give to any young AT looking at this setting would be to go for it!

Don’t think because you have only worked in football, baseball or basketball your whole career that you can’t tackle performing arts or any other setting. I have become a more well-rounded AT because I chose to challenge myself by working in new and different settings.

I was very nervous when I started in this position but am grateful I made the decision to take on this role.

 

 

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The Role of an Athletic Trainer in Managing Diabetes

Posted December 15, 2016

By Mackenzie Simmons, ATC

The theme for National Diabetes Month in November this year was “Managing Diabetes—It’s Not Easy, but it’s Worth it.” There are 2 important aspects to this theme that impacts the work of healthcare providers.

1. It serves as a reminder to all persons diagnosed with diabetes that they are not alone.

2. It serves to educate the population on the importance of managing diabetes correctly to prevent secondary complications including heart attack, stroke, kidney disease, vision loss and amputation.

It is important for healthcare professionals, along with members of the community, to be educated on the risk factors of diabetes as well as any issue that may arise due to improper management. As healthcare providers, Athletic Trainers (AT) have several important roles and responsibilities with diabetes management.

First and foremost, ATs need to educate patients, parents and coaches on what to look out for with hypoglycemia and hyperglycemia. Also, having a treatment plan readily available, along with the patient’s emergency medical forms,  is essential incase an emergency arises. Establishing good rapport with the patient and their family is imperative to gain trust in the relationship.

There are also several tips ATs should provide to your patients with diabetes:

- Know your ABC’s including the following:

* A1C or blood test that measures the average blood sugar level over the past 3 months

* Blood pressure

* Cholesterol

- Get into a routine schedule with your eating habits and physical activity

- Know your blood sugar levels and what to do when they become too high or too low

- Establish a team of healthcare professionals who are able to provide support and answer questions

For more information on this topic, visit the following webpages:

http://www.diabetes.org/diabetes-basics/?loc=db-slabnav

http://www.diabetes.org/diabetes-basics/myths/?loc=db-slabnav

http://www.diabetes.org/living-with-diabetes/?loc=lwd-slabnav

https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/partnership-community-outreach/national-diabetes-month/Pages/default.aspx

 

 

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Choosing the Correct Continuing Education Program

Posted December 13, 2016

Brian Bradley,
MS, LAT, ATC, CSCS

By Brian Bradley, MS, LAT, ATC, CSCS

Obtaining continuing education units (CEUs) can be a frustrating task, but it can also be very rewarding if done correctly. Start by changing your attitude about continuing education (CE). Don’t think about CE as an annoying, time-consuming tasks you are required to do in order to maintain your certification. Try to think of CE as an opportunity to improve your skills and become a better Athletic Trainer (AT).

1. Know what specific CEs you need for your certification and license

If you are an AT who was certified in 2015 or before, 50 CEUs (including at least 10 CEUs from the EBP category) are required by December 31, 2017. If you were certified in 2016, 25 CEUs (including at least 5 CEUs from the EBP category) are required by December 31, 2017Some states also require CEs with each license renewal, sometimes those including medical errors programs or attending live events. Make sure you account for these when scheduling your CE programs.

2. Find CEs that are aligned with your interests or position

For example: If you work with athletes who have prolonged symptoms after concussions, it may be beneficial to attend a seminar in which they cover sub-maximal graded treadmill exercise.

3. Look for CEs that may make you more marketable in the future

Consider taking CE programs that add to your resume and clinical tool kit. Not only may it make you a better clinician, but it may help you land a job in the future.

4. Look for CEs that may satisfy requirements for multiple certifications

If you are an AT certified as a strength and conditioning specialist, look for a class you can use for both certifications.

5. Don’t wait until the December 2017 of a reporting period to get your CEs

Don’t wait to get your CE completed. The danger of waiting until this last minute is that there may not be any classes that fit into your schedule.

6. Look for CEs your employer will reimburse

Paying for CEs can get expensive but sometimes employers will provide their employees a CE budget.

7. Use CEs as a chance to network

Think about attending a seminar that offers CEs for multiple professions (RN, PT, EMT, etc.). This will help other professionals get to know the athletic training profession.

8. Attend a National or Local Athletic Training Meeting

Get to know other ATs in your state or district. Usually these meetings offer a lot of CEs and cover topics that directly impact you.

9. Use CE Course as an Excuse to Travel

Attend a seminar or course in someplace you have never been. Plan your trip to add a day or 2 to sightsee and experience a new location.

If you’re struggling with CEUs, remember the BOC website has a list of live events and home study programs to help you meet your CE requirements. Find CEUs on the BOC website at www.bocatc.org/findCE. You can also check the career education section of the NATA website at https://www.nata.org/career-education/education/online-ceu-opportunities.

Resources

www.bocatc.org/findCE

https://www.nata.org/career-education/education/online-ceu-opportunities

About the Author

Brian Bradley has been a BOC Certified Athletic Trainer since 2008. He is originally from Lawrence, Massachusetts but now live in Orlando, Florida. Bradley earned his undergraduate degree at Merrimack College in North Andover, Massachusetts and his master’s degree at the University of Florida. Bradley has worked in a variety of settings including professional, collegiate and secondary schools and in a physical therapy clinic. He currently works at Orlando Orthopaedic Center in the durable medical equipment (DME) department.  In his spare time, Bradley spends time with his wife, Izzy, and his daughter, Abigail.  He is also a big Boston/New England fan and enjoys running.

 

 

 

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Exercise Intervention for Post-Traumatic Stress Disorder

Posted November 29, 2016

Desi Rotenberg
MS, LAT, ATC

By Desi Rotenberg, MS, LAT, ATC

Since 2000, there is emerging evidence that exercise can and should be used in the therapeutic treatment plan of patients with Post-Traumatic Stress Disorder (PTSD). Before understanding how therapeutic exercise can be used as a modality for PTSD, we must identify a working definition of the disorder.

The National Center for PTSD defines trauma as “a shocking or anxiety-inducing event that a person witnesses or experiences.”1 It is reported that 6 out of every 10 men and 5 out of every 10 women will experience at least 1 traumatic incident in their life.1 While these traumatic experiences can cause acute forms of PTSD, the effects tend to be short lasting and asymptomatic. However, 8 out of every 100 individuals in the United States will suffer from PTSD at some point in their life.1

PTSD is described as an “anxiety disorder that is triggered by witnessing or experiencing a traumatic event.”2 PTSD is most commonly associated with veterans; however, it can also frequently affect survivors of “violent, personal assaults.” These include rape, mugging, domestic violence, childhood abuse, natural disasters, accidents and life threatening illnesses.

It is important to note the athletic population is not exempt from PTSD. Traumatic events that athletes have suffered either in their past or that are related to an athletic injury can cause substantial hindrances in their return to play. The consequences of traumatic stress can interfere with both an athlete’s rehabilitation as well as their return to play status. Furthermore, sport-related trauma can be a result of over-training or violence within sports.3

The main symptoms of PTSD are generalized anxiety, depression, insomnia, dysphoria and general fatigue. While depression is a common consequence of some of life’s most strenuous occurrences, there are physical and physiological benefits to utilizing exercise as a therapeutic intervention.

There have been several studies that have shown positive outcomes on patients with PTSD, and more data is emerging.  In 2009, Cohen and Shamus noted, “Low-to-moderate intensity exercise can elevate mood and reduce anxiety.”2 Additionally, Tsatsoulis and Fountoulakis determined in 2006 that exercise can “act as an overall stress buffer” which in effect can have a positive impact on the symptoms of depression and PTSD.2 Non-randomized controlled studies using physical activity and exercise as an intervention for patients with PTSD showed improvements in body image, prevention of eating disorders, alleviation of anxiety and depressive symptoms and decreased substance abuse.4 Cross-sectional studies have had high self-reports of a correlation between habitual exercise and better mental health.5

In the athletic population, habitual exercise is the activity that is done outside of organized team activities. Other longitudinal surveys have shown that exercise habits early on in an individual’s growth and development, between ages 18-28, can predict freedom from depression later on in their life.6

Farmer et al. surveyed 1,900 adults in 1988 with preexisting depression (causes were variable, some unknown). They determined that individuals who took part in physical exercise ranging from low intensity to rigorous training, successfully made it to the 8-year follow up, and confirmed the researchers’ ability to predict freedom from depression.7 Additionally, the Journal of Clinical Epidemiology published a study in 1994 looking at 1,758 adults with a variety of physical and chronic health problems and self-reported exercise time during a 2-year study period. The majority of these individual reported improvements in well-being, anxiety levels and reported low levels of depression and fatigue.8

There is extensive data on the efficacy of corrective exercise strategies for individuals who are suffering from PTSD as well as any residual behavioral symptoms that are associated with exposure to a traumatic event. While the occurrence of PTSD and injuries from blunt force trauma to the head are only growing in the United States, it will be up to behavioral specialists, occupational therapists, physical therapists and fitness professionals to facilitate an atmosphere that allows individuals to return to their normal activities of daily living.

Resources

1. National Center for PTSD. http://www.ptsd.va.gov. Date Accessed: October 20, 2016.

2. Kim, L. H., Kravitz, L., & Schneider, S. (2012). PTSD & Exercise: What every exercise professional should know. IDEA Fitness J, 9, 20-23.

3. Wenzel, T., & Zhu, L. J. (2013). Posttraumatic Stress in Athletes. Clinical Sports Psychiatry: An International Perspective, 102-114.Lawrence, S., De Silva, M., & Henley, R. (2010). Sports and games for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev, 9.

4.  Lawrence, S., De Silva, M., & Henley, R. (2010). Sports and games for post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev, 9.

5. Salmon, P. (2001). Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical psychology review, 21(1), 33-61.

6. Krause, N., Goldenhar, L., Liang, J., Jay, G., & Maeda, D. (1993). Stress and exercise among the Japanese elderly. Social science & medicine, 36(11), 1429-1441.

7. Farmer, M. E., Locke, B. Z., Moscicki, E. K., Dannenberg, A. L., Larson, D. B., & Radloff, L. S. (1988). Physical activity and depressive symptoms: the NHANES I Epidemiologic Follow-up Study. American Journal of Epidemiology, 128(6), 1340-1351.

8.  Stewart, A. L., Hays, R. D., Wells, K. B., Rogers, W. H., Spritzer, K. L., & Greenfield, S. (1994). Long-term functioning and well-being outcomes associated with physical activity and exercise in patients with chronic conditions in the medical outcomes study. Journal of Clinical Epidemiology, 47, 719–730.

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015. 



In-Depth Look: Athletic Trainer for the United States Soccer Federation

Posted November 21, 2016

Steven Bagus, ATC, NASM-PES is an Athletic Trainer for the United States Soccer Federation.

Describe your setting:

I work with the United States Soccer Federation (USSF). In this setting, I work with a variety of national soccer teams at a variety of locations. This setting allows for a great deal of travel and the opportunity to work with athletes of different ages.

The diversity of coaches, athletes and staff members provides a constantly changing atmosphere. This setting forces me to use all of the tools in my athletic training box. Learning the health history of the players, their needs during training camps or tournaments and the expectations of the coaching staff in a short time frame and an unfamiliar environment helps me to be a more dynamic Athletic Trainer (AT).

How long have you worked in this setting?

My first experience working with the USSF was in 2009, but I entered my current role in January 2016.

Describe your typical day:

A typical trip working for the USSF involves meeting the team at an airport to travel together for international trips or traveling to the location of a domestic camp.

The camp begins with setting up your athletic training facility, typically an empty hotel room. A typical camp has an average of 12 boxes of athletic training supplies. Once your functional athletic training facility is set up, it is important to review the physicals for each athlete. Each day of camp can be different depending on the needs of the team.

As the AT, I am expected to join the team for all team meals, prepare the athletes for practice and games and evaluate and treat the athlete’s post-activity. Each day is exciting, challenging and demanding but can be a very rewarding experience as an AT.

What do you like about your position?

I love that this position allows me to travel all over the world with the highest level of athletes.

What do you dislike about your position?

The biggest challenge of this job is learning the needs and expectations of different athletes and coaches on a regular basis.

What advice do you have about your practice setting for a young AT looking at this setting?

My advice to young professionals looking for this setting is to be very flexible and excited to help the team accomplish their goals. If you are interested in working for a national program, seek out the medical administrator and see where you can help.