Sports: An underutilized tool for patients with disabilities
Sport activities promote health and well-being in this population, which is disproportionately affected by obesity, sedentary lifestyle, and social isolation.
PRACTICE RECOMMENDATIONS
› Recommend physical activity as an adjunct to traditional medical management to maximize physical and psychosocial benefits in patients with intellectual/developmental disabilities. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
For patients with Down syndrome, a complete pre-participation sports physical exam is warranted. Inquire specifically about neck pain or dislocations, heart murmur, cardiac surgery, seizures, sleep issues, history of congenital abdominal defect, hematologic malignancy, and bone pain as part of the focused physical exam.
Look for evidence of patellofemoral instability, pes planus, scoliosis, hallux deformities, decreased muscle tone, and muscular weakness. Check for cataracts and perform a thorough cardiovascular exam to assess for murmur or signs of chronic hypoxia, such as cyanosis. If a heart murmur is detected, refer the patient to a cardiologist.
Patients with Down syndrome are also at increased risk for atlantoaxial instability. A thorough neurologic evaluation to screen for this condition is indicated; however, routine radiologic screening is not needed.12
An annual complete blood cell count and thyroid-stimulating hormone test are recommended for all children with Down syndrome.13 For patients with Down syndrome who are 13 to 21 years of age, an echocardiogram also is recommended for concerning symptoms.13 Ferritin levels also should be assessed annually for patients who are younger than 13 years of age to check for iron-deficiency anemia.13 Consider high-risk screening strategies for patients with diabetes and metabolic syndrome.
Special considerations. Patients with Down syndrome were found to be injured more frequently than individuals with other disabilities during the Special Olympics.14 These patients may be hypersensitive to pain with prolonged pain responses, or unable to verbally communicate their pain or injury.15
Continue to: The complexity of pain assessment...
