The Specialneeds Athlete

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Special-needs athletes include athletes with cerebral palsy, blindness, paralysis, mental retardation, amputation, arthritis,

Table 2-3 The 14-Point Musculoskeletal Screening Examination6



1. Inspection, athlete standing, facing examiner

Symmetry of trunk, upper extremities

2. Forward flexion, extension, rotation, lateral flexion of neck

Cervical spine range of motion

3. Resisted shoulder shrug

Trapezius strength

4. Resisted shoulder abduction

Deltoid strength

5. Internal and external rotation of shoulder

Glenohumeral joint range of motion

6. Extension and flexion of elbow

Elbow range of motion

7. Pronation and supination of forearm

Wrist range of motion

8. Clench fist, spread fingers

Hand and fingers range of motion

9. Inspection, athlete facing away from examiner

Symmetry of truck, upper extremities

10. Back extension, knees straight

Spondylolysis, spondylolisthesis

11. Back flexion with knees straight (see Fig. 2-1)

Spine range of motion, scoliosis, hamstring flexibility

12. Inspection of lower extremities, quadriceps contraction

Alignment, symmetry

13. "Duck walk" four steps (see Fig. 2-2)

Hip, knee, ankle motion, strength/balance

14. Standing on toes, then heels (see Fig. 2-3)

Symmetry, calf strength, balance

Strapse Lackkleid
Figure 2-3 Standing on toes.

muscular dystrophy, and multiple sclerosis. The benefits of exercise for the special-needs athlete are the same as those for other athletes. Additionally, special-needs athletes have fewer pressure ulcers, fewer infections, improved proprioception, increased proficiency using prosthetic devices, and decreased hospitalizations. The Special Olympics and the United States Paralympics require a preparticipation examination to be done within 12 months of competition. An office-based examination is preferred for these athletes. Questions on which the physician should focus are listed in Table 2-4. These questions should be asked and appropriate consultations made if needed. Special attention should be given to the vision, cardiovascular, neurologic, dermatologic, genitourinary, and musculoskeletal portions of the examination. The functional assessment with sport-specific tasks should be done on all athletes with special needs. Diagnostic imaging should be done on all athletes at risk of atlantoaxial instability, including athletes with Down syndrome wanting to compete in judo, equestrian sports, gymnastics, diving, pentathlon, swimming (butterfly stroke and diving starts), high jump, Alpine skiing, snowboarding, squat lift, and


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