Adaptive sports medicine consultations serving adult and pediatric patients

June 04, 2021

Nota: este contenido se creó antes de la pandemia de la enfermedad por coronavirus 2019 (COVID-19) y no describe los protocolos adecuados para la pandemia. Respeta todas las pautas recomendadas por los Centros para el Control y la Prevención de Enfermedades relativas al uso de mascarillas y al distanciamiento físico.

Multiple studies have demonstrated that individuals with disabilities who participate in sports or regular physical activity often experience improvements in their cardiovascular, musculoskeletal and psychosocial health. The list of physical benefits includes prevention of cardiovascular and musculoskeletal deconditioning, bone loss, orthostatic hypotension, deep vein thrombosis, contracture and pressure ulcerations. And within the realm of psychological and social health, regular participation in exercise and athletic competition is associated with increased self-esteem, a more positive self-image, and increased visibility and integration within an individual's community.

When individuals with disabilities experience sports-related injuries, or when they want to start participating in a new sport or physical activity, they have some unique concerns and needs. To address these issues, Mayo Clinic physiatrists Kristin L. Garlanger, D.O., and Amy E. Rabatin, M.D., co-lead a multidisciplinary team of physical medicine and rehabilitation professionals that provides a broad range of services for both pediatric and adult patients at Mayo Clinic's campus in Rochester, Minnesota.

Patients with disabilities seeking this specialized guidance can meet with physiatrists, physical, occupational and recreational therapists, sports psychologists, athletic trainers, sports nutrition dietitians and sports performance professionals. Staff can assist with any of the following goals, for example, and other services tailored to the needs of each individual:

  • Maintenance of fitness
  • Performance improvements for beginners and elite athletes
  • Return-to-sport protocols for beginners and for athletes returning after physical injury or concussion
  • Adaptive equipment recommendations, adjustments and optimization

According to Dr. Rabatin, team members who work with these patients recognize the importance of addressing the complex and wide-ranging nature of these patients' concerns.

"Regardless of our individual training backgrounds and disciplines, we try to think of these athletes holistically," says Dr. Rabatin. "Each athlete is unique. To best support and care for these athletes, we need to use a lens of equity and take into consideration each athlete's ability, goals and interests, in addition to the diagnosis."

Using that approach means that team members work together to assess and address the following:

  • The athlete's mindset, goals, experience level and training methods
  • The athlete's specific disability and typical sequela, taking into consideration, for example, baclofen pump or spine hardware, comorbidities such as spasticity or autonomic dysfunction, diagnosis-related emergencies, and functional history
  • Quality of transfers (if applicable)
  • Sport-specific rules and classification systems
  • Associated equipment considerations, which can include a review of related biomechanics that may affect performance or increase injury risk, recommendations for modifications or a review of how to fix any broken equipment
  • Injury prevention strategies specific to each patient's status and activity

"We also like to ask what our patients are doing for strengthening both in-season and off-season, and whether they cross-train," explains Dr. Garlanger. "Wheelchair-based basketball players, for instance, could benefit from cross-training in an activity that doesn't involve the repetitive forward propulsion. Taking a preventative approach to these athletes' care is of great importance."

Drs. Rabatin and Garlanger expect that the services that this team provides will continue to evolve and expand.

"We are looking forward to growing our offerings and continuing to support athletes on their physical activity and sports journey, whether for recreation or competitive participation," says Dr. Rabatin. "We aim to optimize the health and wellness of our athletes with disabilities, and we are striving to close the gap in health care disparity that already exists in this unique population," adds Dr. Garlanger.